Healthcare Provider Details

I. General information

NPI: 1295750735
Provider Name (Legal Business Name): JOSEPH ROGERS DICKINSON PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

500 E WALNUT ST
EVANSVILLE IN
47713-2438
US

IV. Provider business mailing address

5355 W ESCHE DR
NEWBURGH IN
47630-2917
US

V. Phone/Fax

Practice location:
  • Phone: 812-465-6226
  • Fax: 812-465-6246
Mailing address:
  • Phone: 812-465-6226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number20040459A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: