Healthcare Provider Details

I. General information

NPI: 1396609343
Provider Name (Legal Business Name): DICKERMAN THERAPY & CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2025
Last Update Date: 12/15/2025
Certification Date: 12/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

167 AUBURNDALE AVE
NEWTON MA
02465-1424
US

IV. Provider business mailing address

167 AUBURNDALE AVE
NEWTON MA
02465-1424
US

V. Phone/Fax

Practice location:
  • Phone: 617-590-1331
  • Fax:
Mailing address:
  • Phone: 617-590-1331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MRS. NINA LYNN DICKERMAN
Title or Position: OWNER, PSYCHOTHERAPIST
Credential: LICSW
Phone: 617-590-1331