Healthcare Provider Details

I. General information

NPI: 1831094895
Provider Name (Legal Business Name): EBONY DIXON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2026
Last Update Date: 10/10/2026
Certification Date: 10/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 ELM PL FL 2
BROOKLYN NY
11201-5355
US

IV. Provider business mailing address

563 MOTHER GASTON BLVD APT 3A
BROOKLYN NY
11212-7336
US

V. Phone/Fax

Practice location:
  • Phone: 718-802-0666
  • Fax:
Mailing address:
  • Phone: 347-995-8162
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number132771
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: