Provider Demographics
NPI:1457436842
Name:DICKER, PHYLLIS DEBORAH (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:DEBORAH
Last Name:DICKER
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 HICKS ST
Mailing Address - Street 2:APT A31
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201
Mailing Address - Country:US
Mailing Address - Phone:718-855-5171
Mailing Address - Fax:718-855-5171
Practice Address - Street 1:145 HICKS ST
Practice Address - Street 2:APT A31
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-855-5171
Practice Address - Fax:718-855-5171
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0260741104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
P57379OtherOXFORD
001942OtherGHI
P57379OtherOXFORD