Provider Demographics
NPI:1699562363
Name:DIXON, HYSALENE (CMHC-INTERN)
Entity type:Individual
Prefix:
First Name:HYSALENE
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:CMHC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1571 FULTON AVE APT 5B
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-8230
Mailing Address - Country:US
Mailing Address - Phone:718-872-8653
Mailing Address - Fax:
Practice Address - Street 1:1571 FULTON AVE APT 5B
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-8230
Practice Address - Country:US
Practice Address - Phone:718-872-8653
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-24
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health