Healthcare Provider Details

I. General information

NPI: 1063376440
Provider Name (Legal Business Name): DAWN POSSO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 W NAVAJO ST UNIT 2901
WEST LAFAYETTE IN
47996-2901
US

IV. Provider business mailing address

610 W NAVAJO ST UNIT 2901
WEST LAFAYETTE IN
47996-2901
US

V. Phone/Fax

Practice location:
  • Phone: 765-367-1004
  • Fax:
Mailing address:
  • Phone: 765-367-1004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number34012093A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: