Provider Demographics
NPI:1912664558
Name:DYE, DENNIS M (LCSW)
Entity Type:Individual
Prefix:
First Name:DENNIS
Middle Name:M
Last Name:DYE
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 1:4502 N 36TH ST APT 206
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-3401
Mailing Address - Country:US
Mailing Address - Phone:602-206-2795
Mailing Address - Fax:
Practice Address - Street 1:4502 N 36TH ST APT 206
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-3401
Practice Address - Country:US
Practice Address - Phone:602-206-2795
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-18
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW29211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical