Provider Demographics
NPI:1932135589
Name:DACH, NICHOLAS PETER (LCSW)
Entity Type:Individual
Prefix:MR
First Name:NICHOLAS
Middle Name:PETER
Last Name:DACH
Suffix:
Gender:M
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:PO BOX 5951
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93755-5951
Mailing Address - Country:US
Mailing Address - Phone:559-696-0455
Mailing Address - Fax:559-222-1339
Practice Address - Street 1:2350 W SHAW AVE
Practice Address - Street 2:SUITE 118
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-3401
Practice Address - Country:US
Practice Address - Phone:559-696-0455
Practice Address - Fax:559-222-1339
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-24
Last Update Date:2009-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 186331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000001079OtherFRESNO COUNTY MEDICAL
CALCS 18633OtherL.C.S.W. LICENSE NUMBER
CA000001079OtherFRESNO COUNTY MEDICAL