Healthcare Provider Details

I. General information

NPI: 1467152066
Provider Name (Legal Business Name): MANDY MARIE DIXON LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MANDY MARIE MAXIE

II. Dates (important events)

Enumeration Date: 03/03/2023
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 IKEA DR
WESTAMPTON NJ
08060-5115
US

IV. Provider business mailing address

516 E HOLLY AVE
PITMAN NJ
08071-1737
US

V. Phone/Fax

Practice location:
  • Phone: 609-386-7331
  • Fax:
Mailing address:
  • Phone: 856-449-0819
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number44SC06373300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: