MEDICARE: MR. DEAN R. DICKSON MS

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	103T00000X	Psychologist	PS-005765-L	PA
2	103T00000X	Psychologist	047-0000681	VT

General Provider Information

NPI Number	:	1619020534
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. DEAN R. DICKSON MS

Provider Business Mailing Address
First Line	:	18 ORCHARD WAY
Second Line	:
City	:	YARDLEY
State	:	PA
Zip	:	19067-3051
Country	:	US
Telephone Number	:	215-493-6709
Fax Number	:	215-860-3356

Provider Business Practice Location Address
First Line	:	22 S STATE ST
Second Line	:
City	:	NEWTOWN
State	:	PA
Zip	:	18940-3507
Country	:	US
Telephone Number	:	215-860-3450
Fax Number	:	215-860-3356

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

Provider Enumeration Date	:	01/22/2007
Last Update Date	:	07/08/2007

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