Provider Demographics
NPI:1356132583
Name:DIXON, JANEEN MABEL (MS, CCHW)
Entity type:Individual
Prefix:
First Name:JANEEN
Middle Name:MABEL
Last Name:DIXON
Suffix:
Gender:F
Credentials:MS, CCHW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 CARLISLE ST
Mailing Address - Street 2:
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02907-3606
Mailing Address - Country:US
Mailing Address - Phone:401-215-8792
Mailing Address - Fax:401-215-8792
Practice Address - Street 1:22 CARLISLE ST
Practice Address - Street 2:
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02907-3606
Practice Address - Country:US
Practice Address - Phone:401-215-8792
Practice Address - Fax:401-215-8792
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-15
Last Update Date:2025-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker