MEDICARE: SUSAN 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
1	1041C0700X	Clinical Social Worker	SW#11732	FL

General Provider Information

NPI Number	:	1326586603
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN DIXON LCSW

Provider Business Mailing Address
First Line	:	350 ALT 19 STE C
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	727-254-9183
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 ALT 19 STE C
Second Line	:
City	:	PALM HARBOR
State	:	FL
Zip	:	34683-5303
Country	:	US
Telephone Number	:	727-254-9183
Fax Number	:

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

Provider Enumeration Date	:	02/07/2017
Last Update Date	:	02/07/2017

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Directions to “ SUSAN DIXON LCSW” Practice Location

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