Healthcare Provider Details

I. General information

NPI: 1316722101
Provider Name (Legal Business Name): DAWN MADEN LCDP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DAWN GAUDET

II. Dates (important events)

Enumeration Date: 08/29/2023
Last Update Date: 08/29/2023
Certification Date: 08/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

110 ELMWOOD AVE
PROVIDENCE RI
02907-2423
US

IV. Provider business mailing address

216 KNIGHT AVE
ATTLEBORO MA
02703-7238
US

V. Phone/Fax

Practice location:
  • Phone: 401-300-5757
  • Fax:
Mailing address:
  • Phone: 508-838-7188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDP00961
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: