Provider Demographics
NPI:1144490541
Name:DICKEY, PATRICIA J (LCSW)
Entity type:Individual
Prefix:MS
First Name:PATRICIA
Middle Name:J
Last Name:DICKEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 BEACH 116TH ST
Mailing Address - Street 2:APARTMENT 3R
Mailing Address - City:ROCKAWAY PARK
Mailing Address - State:NY
Mailing Address - Zip Code:11694-2440
Mailing Address - Country:US
Mailing Address - Phone:917-696-1239
Mailing Address - Fax:
Practice Address - Street 1:155 BEACH 116TH ST
Practice Address - Street 2:APT 3R
Practice Address - City:ROCKAWAY PARK
Practice Address - State:NY
Practice Address - Zip Code:11694-2440
Practice Address - Country:US
Practice Address - Phone:917-696-1239
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2013-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076203104100000X
NY078681-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker