Provider Demographics
NPI:1205148103
Name:DIXON, DIRK S (MSW)
Entity type:Individual
Prefix:
First Name:DIRK
Middle Name:S
Last Name:DIXON
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 CONGRESS ST
Mailing Address - Street 2:SUITE 214
Mailing Address - City:SALEM
Mailing Address - State:MA
Mailing Address - Zip Code:01970-5529
Mailing Address - Country:US
Mailing Address - Phone:978-542-1953
Mailing Address - Fax:
Practice Address - Street 1:35 CONGRESS ST
Practice Address - Street 2:SUITE 214
Practice Address - City:SALEM
Practice Address - State:MA
Practice Address - Zip Code:01970-5529
Practice Address - Country:US
Practice Address - Phone:978-542-1953
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-08
Last Update Date:2021-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA216405104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker