=====================================================
General NPI Number Information
=====================================================
NPI Number | 1699852806
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DAWN ALLISON MEGGERSON I LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/01/2006
-----------------------------------------------------
Last Update Date | 10/18/2012
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4001 LONG BEACH BLVD
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90807-2616
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-427-7671
-----------------------------------------------------
Fax | 562-595-4704
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 742
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90801-0742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-212-9970
-----------------------------------------------------
Fax | 562-491-1107
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCS 22206
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------