Healthcare Provider Details

I. General information

NPI: 1710379409
Provider Name (Legal Business Name): DELINDA DYKES
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2015
Last Update Date: 05/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

246 PARK STREET CENTER FOR HUMAN DEVELOPMENT
SPRINGFIELD MA
01107
US

IV. Provider business mailing address

246 PARK ST
WEST SPRINGFIELD MA
01089-3314
US

V. Phone/Fax

Practice location:
  • Phone: 413-733-6624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: