Provider Demographics
NPI:1346202793
Name:DIXON, LISA BETH (MD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:BETH
Last Name:DIXON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1051 RIVERSIDE DR
Mailing Address - Street 2:ROOM 2702 BOX 100
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10032-1007
Mailing Address - Country:US
Mailing Address - Phone:212-543-5041
Mailing Address - Fax:212-543-5085
Practice Address - Street 1:710 W 168TH ST
Practice Address - Street 2:NI-12
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10032-3726
Practice Address - Country:US
Practice Address - Phone:212-305-9758
Practice Address - Fax:212-305-9657
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDD381282084P0800X
NY166644-12084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry