Provider Demographics
NPI:1518538008
Name:DICKENS, CHEREESE
Entity Type:Individual
Prefix:
First Name:CHEREESE
Middle Name:
Last Name:DICKENS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1408B CLINTONVILLE ST
Mailing Address - Street 2:
Mailing Address - City:WHITESTONE
Mailing Address - State:NY
Mailing Address - Zip Code:11357-1861
Mailing Address - Country:US
Mailing Address - Phone:516-780-0770
Mailing Address - Fax:
Practice Address - Street 1:4014 62ND ST
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-4989
Practice Address - Country:US
Practice Address - Phone:718-593-5301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-06
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician