Provider Demographics
NPI:1386701977
Name:DIXEN, JEAN MARIE (PHD)
Entity type:Individual
Prefix:DR
First Name:JEAN
Middle Name:MARIE
Last Name:DIXEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 S CALIFORNIA AVE
Mailing Address - Street 2:SUITE 120
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94306-1641
Mailing Address - Country:US
Mailing Address - Phone:650-347-3536
Mailing Address - Fax:
Practice Address - Street 1:220 S CALIFORNIA AVE
Practice Address - Street 2:SUITE 120
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1641
Practice Address - Country:US
Practice Address - Phone:650-347-3536
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2013-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8187103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist