Individual
DR. DENISE DIXON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D.
Contact information
Practice address
646 MAIN ST, 2ND FLOOR, SUITE 203, PORT JEFFERSON, NY 11777-2235
(631) 456-9426
Mailing address
108 RUSTIC RD, PORT JEFFERSON, NY 11777-2033
(631) 456-9426
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
015481
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
02794076
—
NY
01
—
VN2811
MEDICARE
NY
Enumeration date
06/13/2006
Last updated
10/27/2011
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