Healthcare Provider Details

I. General information

NPI: 1295136943
Provider Name (Legal Business Name): DAWN DESORCIE LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/12/2014
Last Update Date: 03/20/2023
Certification Date: 03/20/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 COURT ST
BINGHAMTON NY
13901-3515
US

IV. Provider business mailing address

184 COURT ST
BINGHAMTON NY
13901-3515
US

V. Phone/Fax

Practice location:
  • Phone: 607-584-4465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number079550
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number082471
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: