Provider Demographics
NPI: | 1619598810 |
---|---|
Name: | DICKENS SANOMI CORP |
Entity Type: | Organization |
Organization Name: | DICKENS SANOMI CORP |
Other - Org Name: | DSA THERAPY & HEALTH SERVICES LLC |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | THERAPY MANAGER |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | EURYDICE |
Authorized Official - Middle Name: | |
Authorized Official - Last Name: | DEJEAN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 954-306-3914 |
Mailing Address - Street 1: | 6820 W SUNRISE BLVD |
Mailing Address - Street 2: | |
Mailing Address - City: | PLANTATION |
Mailing Address - State: | FL |
Mailing Address - Zip Code: | 33313-4570 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 713-732-6715 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6820 W SUNRISE BLVD |
Practice Address - Street 2: | |
Practice Address - City: | PLANTATION |
Practice Address - State: | FL |
Practice Address - Zip Code: | 33313-4570 |
Practice Address - Country: | US |
Practice Address - Phone: | 713-732-6715 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-04-29 |
Last Update Date: | 2023-10-16 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 103TM1800X | Behavioral Health & Social Service Providers | Psychologist | Intellectual & Developmental Disabilities | Group - Multi-Specialty |
No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
No | 103TB0200X | Behavioral Health & Social Service Providers | Psychologist | Cognitive & Behavioral | Group - Multi-Specialty |
No | 103TS0200X | Behavioral Health & Social Service Providers | Psychologist | School | Group - Multi-Specialty |
No | 163WS0200X | Nursing Service Providers | Registered Nurse | School | Group - Multi-Specialty |
No | 224ZF0002X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapy Assistant | Feeding, Eating & Swallowing | Group - Multi-Specialty |
No | 225100000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | Group - Multi-Specialty | |
No | 225X00000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Occupational Therapist | Group - Multi-Specialty | |
No | 235Z00000X | Speech, Language and Hearing Service Providers | Speech-Language Pathologist | Group - Multi-Specialty |