Provider Demographics
NPI:1942416839
Name:DEDIC, JAMES GEORGE (LCSW)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:GEORGE
Last Name:DEDIC
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 1:27 COPRA LN
Mailing Address - Street 2:
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-4644
Mailing Address - Country:US
Mailing Address - Phone:310-573-1496
Mailing Address - Fax:310-573-1496
Practice Address - Street 1:27 COPRA LN
Practice Address - Street 2:
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-4644
Practice Address - Country:US
Practice Address - Phone:310-573-1496
Practice Address - Fax:310-573-1496
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW 166361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical