Individual
EBONY DIX
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
20 YORK ST RM 226, NEW HAVEN, CT 06510
(203) 688-9503
Mailing address
184 LIBERTY ST, NEW HAVEN, CT 06519-1625
(203) 688-1936
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
27050
WV
2084P0800X
Psychiatry Physician
Primary
61178
CT
390200000X
Student in an Organized Health Care Education/Training Program
27050
WV
Other
Enumeration date
06/17/2014
Last updated
05/08/2019
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