Healthcare Provider Details

I. General information

NPI: 1245261254
Provider Name (Legal Business Name): DAWN ANNE DORCAS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 09/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 ACADEMY ST
ROSCOE NY
12776-5300
US

IV. Provider business mailing address

PO BOX 429
ROSCOE NY
12776-0429
US

V. Phone/Fax

Practice location:
  • Phone: 607-498-4126
  • Fax:
Mailing address:
  • Phone: 607-498-4126
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number076100
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number1148921
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: