Provider Demographics
NPI:1790068344
Name:PATRICIA S DIXON-PSYD
Entity Type:Organization
Organization Name:PATRICIA S DIXON-PSYD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:SHALENE
Authorized Official - Last Name:DIXON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:727-322-6123
Mailing Address - Street 1:PO BOX 47918
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33743-7918
Mailing Address - Country:US
Mailing Address - Phone:727-322-6143
Mailing Address - Fax:
Practice Address - Street 1:5348 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8106
Practice Address - Country:US
Practice Address - Phone:727-322-6123
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY8356251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
1598046286OtherNPI