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NPI Code Detail

MEDICARE: JOHN A DICKE PSYD

MEDICARE: JOHN A DICKE PSYD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TC0700XClinical Psychologist1980CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11980OTHERCOSTATE LICENSE
211366428OTHERCOCAQH PIN

General Provider Information

NPI Number : 1023377991
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN A DICKE PSYD
Provider Business Mailing Address
First Line : 1 KALISA WAY
Second Line : STE 101
City : PARAMUS
State : NJ
Zip : 07652-3508
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Provider Business Practice Location Address
First Line : 3701 W RADCLIFF AVE
Second Line :
City : DENVER
State : CO
Zip : 80236-3645
Country : US
Telephone Number : 888-948-6789
Fax Number : 877-345-3501
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2012
Last Update Date : 01/13/2023

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Directions to “ JOHN A DICKE PSYD” Practice Location

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