Healthcare Provider Details

I. General information

NPI: 1902423478
Provider Name (Legal Business Name): DAWN SHORES LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 06/15/2026
Certification Date: 06/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 BERNARD ST
SOCORRO NM
87801-4585
US

IV. Provider business mailing address

805 VALENCIA DR NE
ALBUQUERQUE NM
87108-1751
US

V. Phone/Fax

Practice location:
  • Phone: 505-228-5757
  • Fax:
Mailing address:
  • Phone: 505-228-5757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2022-1031
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: