1073734109 NPI number — MS. MARY A DICKSON ANDERSEN LCSW

Table of content: MS. MARY A DICKSON ANDERSEN LCSW (NPI 1073734109)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073734109 NPI number — MS. MARY A DICKSON ANDERSEN LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DICKSON ANDERSEN
Provider First Name:
MARY
Provider Middle Name:
A
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DICKSON
Provider Other First Name:
MARY
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073734109
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
316 BROAD ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RED BANK
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07701-2154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
732-219-0737
Provider Business Mailing Address Fax Number:
732-530-5446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
316 BROAD ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RED BANK
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07701-2154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
732-219-0737
Provider Business Practice Location Address Fax Number:
732-530-5446
Provider Enumeration Date:
05/02/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  44SC00370800 , registered in the state of NJ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com