1720081367 NPI number — DEAN A. DICKERSON, PH.D.

Table of content: (NPI 1720081367)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720081367 NPI number — DEAN A. DICKERSON, PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
DEAN A. DICKERSON, PH.D.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PSYCHOLOGICAL RESOURCE ASSOCIATES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1720081367
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1627 OAK AVE
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
DAVIS
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95616-1072
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
530-756-0555
Provider Business Mailing Address Fax Number:
530-756-1368

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1627 OAK AVE
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
DAVIS
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
95616-1072
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
530-756-0555
Provider Business Practice Location Address Fax Number:
530-756-1368
Provider Enumeration Date:
05/27/2005

Additional Information

Authorized Official

Authorized Official Last Name:
DICKERSON
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
AMES
Authorized Official Title or Position:
PSYCHOLOGIST/OWNER
Authorized Official Telephone Number:
530-756-0555

Provider Taxonomy Codes

  • Taxonomy code: 103TP2701X , with the licence number:  PSY6149 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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