Healthcare Provider Details

I. General information

NPI: 1619355740
Provider Name (Legal Business Name): GREGORY DAWSON II LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2015
Last Update Date: 05/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

IV. Provider business mailing address

2615 E CLINTON AVE
FRESNO CA
93703-2223
US

V. Phone/Fax

Practice location:
  • Phone: 559-225-6100
  • Fax: 559-228-5377
Mailing address:
  • Phone: 559-225-6100
  • Fax: 559-228-5377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number12299
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: