Provider Demographics
NPI:1104160050
Name:DICENZO, ANTHONY (LMFT)
Entity type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:DICENZO
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:946 SW VETERANS WAY STE 102
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2745
Mailing Address - Country:US
Mailing Address - Phone:619-300-5224
Mailing Address - Fax:619-300-5224
Practice Address - Street 1:946 SW VETERANS WAY STE 102
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2745
Practice Address - Country:US
Practice Address - Phone:619-300-5224
Practice Address - Fax:619-300-5224
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-15
Last Update Date:2019-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41926106H00000X
ORT1029106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist