Provider Demographics
NPI:1952439614
Name:WEST-DIXON, IRENE V (LGSW)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:V
Last Name:WEST-DIXON
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2621 E MADISON ST
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21205-1703
Mailing Address - Country:US
Mailing Address - Phone:410-276-7049
Mailing Address - Fax:
Practice Address - Street 1:122 WEBER ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-4106
Practice Address - Country:US
Practice Address - Phone:410-752-5525
Practice Address - Fax:410-752-5531
Is Sole Proprietor?:No
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG08606104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker