MEDICARE: MS. DOREEN SISK DICKINSON LPC

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	101YP2500X	Professional Counselor	37PC01221300	NJ
2	101YM0800X	Mental Health Counselor	017335	NY
3	101YP2500X	Professional Counselor	PC006867	PA
4	101YP2500X	Professional Counselor	LPC16655	AZ

General Provider Information

NPI Number	:	1629412226
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DOREEN SISK DICKINSON LPC

Provider Business Mailing Address
First Line	:	9820 N CENTRAL AVE UNIT 233
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1061
Country	:	US
Telephone Number	:	570-878-2522
Fax Number	:

Provider Business Practice Location Address
First Line	:	9820 N CENTRAL AVE UNIT 233
Second Line	:
City	:	PHOENIX
State	:	AZ
Zip	:	85020-1061
Country	:	US
Telephone Number	:	570-878-2522
Fax Number	:

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

Provider Enumeration Date	:	04/25/2013
Last Update Date	:	01/13/2026

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