MEDICARE: HYSALENE DIXON CMHC-LP

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1699562363
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HYSALENE DIXON CMHC-LP

Provider Business Mailing Address
First Line	:	1571 FULTON AVE APT 5B
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10457-8230
Country	:	US
Telephone Number	:	718-872-8653
Fax Number	:

Provider Business Practice Location Address
First Line	:	99 WALL ST STE 1461
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10005-4301
Country	:	US
Telephone Number	:	718-872-8653
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/24/2025
Last Update Date	:	01/05/2026

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