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NPI Code Detail

MEDICARE: DR. DENISE DIXON PH.D.

MEDICARE: DR. DENISE DIXON PH.D.
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
1103TC0700XClinical Psychologist015481NY

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1VN2811OTHERNYMEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1457394983
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DENISE DIXON PH.D.
Provider Business Mailing Address
First Line : 108 RUSTIC RD
Second Line :
City : PORT JEFFERSON
State : NY
Zip : 11777-2033
Country : US
Telephone Number : 631-456-9426
Fax Number :
Provider Business Practice Location Address
First Line : 646 MAIN ST
Second Line : 2ND FLOOR, SUITE 203
City : PORT JEFFERSON
State : NY
Zip : 11777-2235
Country : US
Telephone Number : 631-456-9426
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/13/2006
Last Update Date : 10/27/2011

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