Provider Demographics
NPI:1790216943
Name:LABORDE, DIXIE
Entity Type:Individual
Prefix:
First Name:DIXIE
Middle Name:
Last Name:LABORDE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DIXIE
Other - Middle Name:
Other - Last Name:LABORDE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,ED
Mailing Address - Street 1:247 W 145TH ST
Mailing Address - Street 2:APT3F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10039-4004
Mailing Address - Country:US
Mailing Address - Phone:646-271-1475
Mailing Address - Fax:
Practice Address - Street 1:247 W 145TH ST
Practice Address - Street 2:APT 3F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10039-4004
Practice Address - Country:US
Practice Address - Phone:646-271-1475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY854241174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist