Provider Demographics
NPI:1972668663
Name:DICK, EDWARD STEPHEN (LCSW)
Entity Type:Individual
Prefix:
First Name:EDWARD
Middle Name:STEPHEN
Last Name:DICK
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 1:75 PINE VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:HOOSICK FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:12090-3808
Mailing Address - Country:US
Mailing Address - Phone:518-265-1614
Mailing Address - Fax:518-677-2290
Practice Address - Street 1:15 W MAIN ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:NY
Practice Address - Zip Code:12816-1118
Practice Address - Country:US
Practice Address - Phone:518-677-2290
Practice Address - Fax:518-677-2290
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-25
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0279021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY000405869003OtherBLUE SHIELD OF NENY
NYN3572OtherEMPIRE HEALTHCHOICE
NY7400918OtherGHI
NY132738OtherVALUE OPTIONS
NY7400918OtherGHI