Provider Demographics
NPI:1053896845
Name:DIMMICK, WILLIAM KENNEY (LICSW)
Entity type:Individual
Prefix:
First Name:WILLIAM
Middle Name:KENNEY
Last Name:DIMMICK
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:148 TREMONT ST
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02458-2131
Mailing Address - Country:US
Mailing Address - Phone:617-332-2474
Mailing Address - Fax:
Practice Address - Street 1:148 TREMONT ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:MA
Practice Address - Zip Code:02458-2131
Practice Address - Country:US
Practice Address - Phone:617-332-2474
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-27
Last Update Date:2018-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker