Provider Demographics
NPI:1245370337
Name:GARVEY-DICKEY, LINDA SUSAN
Entity type:Individual
Prefix:MS
First Name:LINDA
Middle Name:SUSAN
Last Name:GARVEY-DICKEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:872 FURNACE BROOK PKWY
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-1711
Mailing Address - Country:US
Mailing Address - Phone:617-472-6828
Mailing Address - Fax:
Practice Address - Street 1:37 DERBY ST STE 1
Practice Address - Street 2:
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043-3738
Practice Address - Country:US
Practice Address - Phone:781-740-1522
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALMHC 3102174400000X
MA3102101YM0800X
MA1336101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered174400000XOther Service ProvidersSpecialist
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALM1345OtherBLUE CROSS