Healthcare Provider Details

I. General information

NPI: 1639002561
Provider Name (Legal Business Name): NEW DAWN THERAPY LCSW PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2026
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 13TH ST STE B5
MODESTO CA
95354-2456
US

IV. Provider business mailing address

615 13TH ST STE B5
MODESTO CA
95354-2456
US

V. Phone/Fax

Practice location:
  • Phone: 209-554-2249
  • Fax: 888-410-2682
Mailing address:
  • Phone: 209-554-2249
  • Fax: 888-410-2682

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: DAWN MARIE COSTA
Title or Position: CEO
Credential: LCSW
Phone: 209-505-4480