Healthcare Provider Details

I. General information

NPI: 1790068344
Provider Name (Legal Business Name): PATRICIA S DIXON-PSYD
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2011
Last Update Date: 09/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5348 1ST AVE N
ST PETERSBURG FL
33710-8106
US

IV. Provider business mailing address

PO BOX 47918
ST PETERSBURG FL
33743-7918
US

V. Phone/Fax

Practice location:
  • Phone: 727-322-6123
  • Fax:
Mailing address:
  • Phone: 727-322-6143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberPY8356
License Number StateFL

VIII. Authorized Official

Name: DR. PATRICIA SHALENE DIXON
Title or Position: CLINICAL PSYCHOLOGIST
Credential: PSY.D.
Phone: 727-322-6123