Provider Demographics
NPI:1013772672
Name:DIXON-GLAZE, SHANIKA (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANIKA
Middle Name:
Last Name:DIXON-GLAZE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATE ROUTE 34 STE 301
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-3485
Mailing Address - Country:US
Mailing Address - Phone:732-858-1533
Mailing Address - Fax:
Practice Address - Street 1:1000 STATE ROUTE 34 STE 301
Practice Address - Street 2:
Practice Address - City:MATAWAN
Practice Address - State:NJ
Practice Address - Zip Code:07747-3485
Practice Address - Country:US
Practice Address - Phone:732-858-1533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-13
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSW-GTL-21-02384104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker