Provider Demographics
NPI:1740586494
Name:DEARIE, DENNIS A (MFT)
Entity Type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:A
Last Name:DEARIE
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8508 CALLE DE BUENA FE
Mailing Address - Street 2:
Mailing Address - City:EL CAJON
Mailing Address - State:CA
Mailing Address - Zip Code:92021-2093
Mailing Address - Country:US
Mailing Address - Phone:619-938-9712
Mailing Address - Fax:619-938-9712
Practice Address - Street 1:8508 CALLE DE BUENA FE
Practice Address - Street 2:
Practice Address - City:EL CAJON
Practice Address - State:CA
Practice Address - Zip Code:92021-2093
Practice Address - Country:US
Practice Address - Phone:619-938-9712
Practice Address - Fax:619-938-9712
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-27
Last Update Date:2011-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36044106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist