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NPI Code Detail

MEDICARE: JACQUELINE DAWSON MS

MEDICARE: JACQUELINE DAWSON MS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1396965380
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACQUELINE DAWSON MS
Provider Business Mailing Address
First Line : 11031 NE 6TH AVE
Second Line :
City : MIAMI
State : FL
Zip : 33161-7182
Country : US
Telephone Number : 305-398-6100
Fax Number : 305-757-4465
Provider Business Practice Location Address
First Line : 2600 SW 4TH AVE
Second Line :
City : FT LAUDERDALE
State : FL
Zip : 33315-2610
Country : US
Telephone Number : 954-467-4657
Fax Number : 954-767-9804
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/01/2007
Last Update Date : 07/08/2007

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Directions to “ JACQUELINE DAWSON MS” Practice Location

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