MEDICARE: EILEEN DYKEMAN MHC

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	101YM0800X	Mental Health Counselor	MHC00051	RI

General Provider Information

NPI Number	:	1164452199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EILEEN DYKEMAN MHC

Provider Business Mailing Address
First Line	:	4800 N SCOTTSDALE RD STE 2500
Second Line	:
City	:	SCOTTSDALE
State	:	AZ
Zip	:	85251-7630
Country	:	US
Telephone Number	:	401-572-3313
Fax Number	:

Provider Business Practice Location Address
First Line	:	989 RESERVOIR AVE STE 101
Second Line	:
City	:	CRANSTON
State	:	RI
Zip	:	02910-5138
Country	:	US
Telephone Number	:	401-572-3313
Fax Number	:

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

Provider Enumeration Date	:	07/04/2006
Last Update Date	:	08/06/2024

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