Provider Demographics
NPI:1104595883
Name:DIXON, BRIANNA (LMSW)
Entity type:Individual
Prefix:
First Name:BRIANNA
Middle Name:
Last Name:DIXON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 JANE LACEY DR APT A
Mailing Address - Street 2:
Mailing Address - City:ENDICOTT
Mailing Address - State:NY
Mailing Address - Zip Code:13760-3721
Mailing Address - Country:US
Mailing Address - Phone:570-933-4837
Mailing Address - Fax:
Practice Address - Street 1:2621 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6216
Practice Address - Country:US
Practice Address - Phone:315-570-5058
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-07
Last Update Date:2021-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112502104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker