Provider Demographics
NPI:1801023882
Name:DIXON, TROY B (MS, BCBA)
Entity Type:Individual
Prefix:
First Name:TROY
Middle Name:B
Last Name:DIXON
Suffix:
Gender:M
Credentials:MS, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:596 AZALEA LN
Mailing Address - Street 2:APT 15
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1871
Mailing Address - Country:US
Mailing Address - Phone:772-924-0020
Mailing Address - Fax:
Practice Address - Street 1:596 AZALEA LN
Practice Address - Street 2:APT 15
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1871
Practice Address - Country:US
Practice Address - Phone:772-924-0020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-17
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690153196Medicaid
FL690153198Medicaid