Provider Demographics
NPI:1467152066
Name:DIXON, MANDY MARIE (LSW)
Entity Type:Individual
Prefix:
First Name:MANDY
Middle Name:MARIE
Last Name:DIXON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:MANDY
Other - Middle Name:MARIE
Other - Last Name:MAXIE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:516 E HOLLY AVE
Mailing Address - Street 2:
Mailing Address - City:PITMAN
Mailing Address - State:NJ
Mailing Address - Zip Code:08071-1737
Mailing Address - Country:US
Mailing Address - Phone:856-449-0819
Mailing Address - Fax:
Practice Address - Street 1:1051 W SHERMAN AVE STE A
Practice Address - Street 2:
Practice Address - City:VINELAND
Practice Address - State:NJ
Practice Address - Zip Code:08360-6931
Practice Address - Country:US
Practice Address - Phone:856-566-7036
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-03
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06786700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker