MEDICARE: AUDREY DAWSON PSY.D

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
1	103TC0700X	Clinical Psychologist	PY10387	FL

General Provider Information

NPI Number	:	1578020236
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AUDREY DAWSON PSY.D

Provider Business Mailing Address
First Line	:	2407 BELMONT LN
Second Line	:
City	:	NORTH LAUDERDALE
State	:	FL
Zip	:	33068-4294
Country	:	US
Telephone Number	:	954-445-4630
Fax Number	:	305-919-8119

Provider Business Practice Location Address
First Line	:	1451 W CYPRESS CREEK RD STE 300
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33309-1953
Country	:	US
Telephone Number	:	954-445-4630
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/28/2019
Last Update Date	:	09/16/2024

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