Healthcare Provider Details

I. General information

NPI: 1619355260
Provider Name (Legal Business Name): DAWN DECOSTA PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2015
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 N MAIN ST FL 5
ATTLEBORO MA
02703-2282
US

IV. Provider business mailing address

792 S MAIN ST STE 102
MANSFIELD MA
02048-3137
US

V. Phone/Fax

Practice location:
  • Phone: 508-409-0000
  • Fax: 508-492-2964
Mailing address:
  • Phone: 508-470-9783
  • Fax: 508-231-9020

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2280575
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number065101-23
License Number StateNH
# 3
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number065101-21
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: