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General NPI Number Information
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NPI Number | 1053744532
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Entity Type | Individual
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Provider Name | MRS. DAWN CRYSTAL GUDMUNDSEN
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Gender | Female
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Dates
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Enumeration Date | 08/19/2013
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Last Update Date | 08/30/2021
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Provider Practice Location Address
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Address Line | 229 LAUREL RD
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City | EAST NORTHPORT
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State | NY
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Zip | 11731-1118
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Country | US
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Telephone | 484-965-9966
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Fax | 484-231-8631
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Provider Business Mailing Address
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Address Line | 640 FREEDOM BUSINESS CTR DR STE 220
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City | KING OF PRUSSIA
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State | PA
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Zip | 19406-1376
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Country | US
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Telephone | 484-965-9966
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Fax | 484-231-8631
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 703164131
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 504297111
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 001033
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License Number State | NY
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