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NPI Code Detail

MEDICARE: TARA DIXON LCSW

MEDICARE:   TARA  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
1101Y00000XCounselor
2101YM0800XMental Health Counselor
3104100000XSocial Worker
41041C0700XClinical Social WorkerSW18842FL
5106H00000XMarriage & Family Therapist

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841616810
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA DIXON LCSW
Provider Business Mailing Address
First Line : 1155 S SEMORAN BLVD STE 1150
Second Line :
City : WINTER PARK
State : FL
Zip : 32792-5505
Country : US
Telephone Number : 321-746-3889
Fax Number : 386-753-9265
Provider Business Practice Location Address
First Line : 1035 S SEMORAN BLVD
Second Line : SUITE 1047
City : WINTER PARK
State : FL
Zip : 32792-5526
Country : US
Telephone Number : 321-746-3889
Fax Number : 386-753-9265
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/13/2014
Last Update Date : 08/26/2021

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