Provider Demographics
NPI:1619020534
Name:DICKSON, DEAN R (MS)
Entity Type:Individual
Prefix:MR
First Name:DEAN
Middle Name:R
Last Name:DICKSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ORCHARD WAY
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-3051
Mailing Address - Country:US
Mailing Address - Phone:215-493-6709
Mailing Address - Fax:215-860-3356
Practice Address - Street 1:22 S STATE ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3507
Practice Address - Country:US
Practice Address - Phone:215-860-3450
Practice Address - Fax:215-860-3356
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-005765-L103T00000X
VT047-0000681103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist