Provider Demographics
NPI:1508118670
Name:DICKMAN, THOMAS (LCSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:DICKMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1784 S 800 E
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84105-3142
Mailing Address - Country:US
Mailing Address - Phone:801-467-1756
Mailing Address - Fax:
Practice Address - Street 1:5250 S COMMERCE DR
Practice Address - Street 2:SUITE 250
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-7926
Practice Address - Country:US
Practice Address - Phone:801-261-3500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-10-12
Last Update Date:2012-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13984235011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical