Provider Demographics
NPI:1346503836
Name:DIXON, LISBETH L (MS SPECIAL ED)
Entity Type:Individual
Prefix:MS
First Name:LISBETH
Middle Name:L
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS SPECIAL ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:78 HAWTHORNE ST APT 2E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11225-5724
Mailing Address - Country:US
Mailing Address - Phone:347-845-1856
Mailing Address - Fax:
Practice Address - Street 1:1101 LIVINGSTON STREET
Practice Address - Street 2:SUITE 11201
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201
Practice Address - Country:US
Practice Address - Phone:718-625-4055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-19
Last Update Date:2012-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY462603101174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist