Provider Demographics
NPI:1730319823
Name:DICKERSON, PAUL (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:DICKERSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 N JACKSON ST STE 300
Mailing Address - Street 2:
Mailing Address - City:MEDIA
Mailing Address - State:PA
Mailing Address - Zip Code:19063-2530
Mailing Address - Country:US
Mailing Address - Phone:610-557-1991
Mailing Address - Fax:
Practice Address - Street 1:600 N JACKSON ST STE 300
Practice Address - Street 2:
Practice Address - City:MEDIA
Practice Address - State:PA
Practice Address - Zip Code:19063-2530
Practice Address - Country:US
Practice Address - Phone:610-557-1991
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-07-23
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1271241041C0700X
PACW0230911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical