Provider Demographics
NPI:1003409004
Name:DICKSON, BANU
Entity type:Individual
Prefix:
First Name:BANU
Middle Name:
Last Name:DICKSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SAIBANDHAVI
Other - Middle Name:
Other - Last Name:MUTTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3255 HALF MOON BAY CIR
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-5861
Mailing Address - Country:US
Mailing Address - Phone:926-375-7778
Mailing Address - Fax:
Practice Address - Street 1:930 WESTACRE RD
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3224
Practice Address - Country:US
Practice Address - Phone:916-375-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-19
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1130261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical