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NPI Code Detail

MEDICARE: JOHN DIXON LCSW

MEDICARE: JOHN DIXON LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker
21041C0700XClinical Social Worker004431CT

General Provider Information

NPI Number : 1023256930
Entity Type Code : Individual
Provider Name (Legal Business Name) : JOHN DIXON LCSW
Provider Business Mailing Address
First Line : 56 ELM DR
Second Line :
City : NEWTOWN
State : CT
Zip : 06470-2048
Country : US
Telephone Number : 860-428-5115
Fax Number :
Provider Business Practice Location Address
First Line : 430 NEW PARK AVE
Second Line :
City : WEST HARTFORD
State : CT
Zip : 06110-1142
Country : US
Telephone Number : 475-271-7944
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/30/2009
Last Update Date : 09/12/2024

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