Healthcare Provider Details

I. General information

NPI: 1962017145
Provider Name (Legal Business Name): DAWN L SORIANO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2020
Last Update Date: 10/28/2024
Certification Date: 10/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7578 E BRIGADE DR
NAMPA ID
83687-6919
US

IV. Provider business mailing address

7578 E BRIGADE DR
NAMPA ID
83687-6919
US

V. Phone/Fax

Practice location:
  • Phone: 210-632-8702
  • Fax:
Mailing address:
  • Phone: 210-632-8702
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: