MEDICARE: CATHERINE A DICKEN

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
1	104100000X	Social Worker	078342	NY

General Provider Information

NPI Number	:	1164387999
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CATHERINE A DICKEN

Provider Business Mailing Address
First Line	:	21 MAPLE AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8752
Country	:	US
Telephone Number	:	631-213-5096
Fax Number	:

Provider Business Practice Location Address
First Line	:	21 MAPLE AVE
Second Line	:
City	:	BAY SHORE
State	:	NY
Zip	:	11706-8752
Country	:	US
Telephone Number	:	631-213-5096
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/23/2025
Last Update Date	:	12/23/2025

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Directions to “ CATHERINE A DICKEN ” Practice Location

Language	Start Address	Practice Location

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