Active NPI
Mark RM Dickmann, MSW, LCSW
- Clinical Social Worker
- Durango, CO
National Provider Identifier
1164620886
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 1741
- Practice address
- 2855 Main Ave
Suite a-107
Durango, CO 81301-5956 - Phone
- (970) 259-5711
- NPI assigned
- Jul 3, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 1741 | CO | Primary |
Addresses
Primary practice location
2855 Main Ave
Suite a-107
Durango, CO 81301-5956
Mailing address
2855 Main Ave
Suite a-107
Durango, CO 81301-5956
Phone (970) 259-5711
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jul 1, 2021 through Jul 1, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1741 | CO | MD | Surgical Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1183420800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1325203200000",
"number": "1164620886",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2855 MAIN AVE",
"address_2": "SUITE A-107",
"city": "DURANGO",
"state": "CO",
"postal_code": "813015956",
"telephone_number": "970-259-5711"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2855 MAIN AVE",
"address_2": "SUITE A-107",
"city": "DURANGO",
"state": "CO",
"postal_code": "813015956",
"telephone_number": "970-259-5711"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKMANN",
"first_name": "MARK",
"middle_name": "RM",
"credential": "MSW, LCSW",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-07-03",
"last_updated": "2011-12-30",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "CO",
"license": "1741",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Durango, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 30, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.