Provider Demographics
NPI:1891702304
Name:DYER, SANDRA A (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:A
Last Name:DYER
Suffix:
Gender:F
Credentials: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 W DIVISION ST
Mailing Address - Street 2:SUITE 16
Mailing Address - City:DOVER
Mailing Address - State:DE
Mailing Address - Zip Code:19904-2702
Mailing Address - Country:US
Mailing Address - Phone:302-735-7738
Mailing Address - Fax:302-735-8560
Practice Address - Street 1:1679 S DUPONT HWY
Practice Address - Street 2:SUITE 16
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-5101
Practice Address - Country:US
Practice Address - Phone:302-735-7738
Practice Address - Fax:302-735-8560
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2016-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-0000296101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000021573Medicaid