Provider Demographics
NPI:1932161023
Name:DIXON, MICHAEL S (PHD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:S
Last Name:DIXON
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:126 EVERETT RD
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:ME
Mailing Address - Zip Code:04210-8545
Mailing Address - Country:US
Mailing Address - Phone:207-783-3052
Mailing Address - Fax:
Practice Address - Street 1:126 EVERETT RD
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:ME
Practice Address - Zip Code:04210-8545
Practice Address - Country:US
Practice Address - Phone:207-783-3052
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-04
Last Update Date:2013-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS364103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME226970000Medicaid
ME003482OtherANTHEM BC/BS
ME226970000Medicaid