Provider Demographics
NPI:1700156973
Name:ADICKMAN, JOAN D (PH D)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:D
Last Name:ADICKMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 I U WILLETS RD
Mailing Address - Street 2:
Mailing Address - City:ALBERTSON
Mailing Address - State:NY
Mailing Address - Zip Code:11507-1516
Mailing Address - Country:US
Mailing Address - Phone:516-465-1687
Mailing Address - Fax:
Practice Address - Street 1:58 TAIN DR
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-4435
Practice Address - Country:US
Practice Address - Phone:516-829-2332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-05
Last Update Date:2012-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012324-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist