Healthcare Provider Details

I. General information

NPI: 1659512440
Provider Name (Legal Business Name): DAWN MARIE CISEWSKI PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN MARIE REDONDO

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 08/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

155 MAPLE ST SUITE 203
SPRINGFIELD MA
01105-1828
US

IV. Provider business mailing address

155 MAPLE ST SUITE 203
SPRINGFIELD MA
01105-1828
US

V. Phone/Fax

Practice location:
  • Phone: 413-734-3331
  • Fax: 413-739-1652
Mailing address:
  • Phone: 413-734-3331
  • Fax: 413-739-1652

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number8187
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8187
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: