Provider Demographics
NPI:1851314777
Name:DICKSON, AMY BROOKE (PSY D)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:BROOKE
Last Name:DICKSON
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1340 POYDRAS ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70112-1221
Mailing Address - Country:US
Mailing Address - Phone:504-412-1860
Mailing Address - Fax:
Practice Address - Street 1:NOAH- LSUHSC PSYCHIATRY
Practice Address - Street 2:210 STATE STREET, RM. 3111S
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70118
Practice Address - Country:US
Practice Address - Phone:504-896-2655
Practice Address - Fax:504-897-4781
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA834103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1113093Medicaid
LA4B378F669Medicare PIN
LA4B378Medicare PIN