Provider Demographics
NPI:1508354879
Name:DIXON, ELIZABETH MOONEY (LSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MOONEY
Last Name:DIXON
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 BISHOP RD APT 1
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02170-3626
Mailing Address - Country:US
Mailing Address - Phone:339-933-1909
Mailing Address - Fax:
Practice Address - Street 1:20 BISHOP RD APT 1
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02170-3626
Practice Address - Country:US
Practice Address - Phone:339-933-1909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-23
Last Update Date:2018-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA314636104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker