Provider Demographics
NPI:1629408331
Name:SIERRA, DALLAS CLAY (LICSW)
Entity Type:Individual
Prefix:MR
First Name:DALLAS
Middle Name:CLAY
Last Name:SIERRA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5436 SW 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33155-6351
Mailing Address - Country:US
Mailing Address - Phone:202-556-3456
Mailing Address - Fax:
Practice Address - Street 1:5436 SW 57TH AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33155-6351
Practice Address - Country:US
Practice Address - Phone:202-556-3451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-11-15
Last Update Date:2022-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500798211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical