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General NPI Number Information
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NPI Number | 1831662220
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Entity Type | Individual
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Provider Name | DAWN GILBERT IPPOLITI MAMA, LCAT, LPAT
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Gender | Female
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Dates
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Enumeration Date | 01/08/2019
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 202 MOUNTAIN AVE STE 3
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City | WESTFIELD
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State | NJ
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Zip | 07090-3152
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Country | US
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Telephone | 917-374-7977
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Fax |
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Provider Business Mailing Address
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Address Line | 202 MOUNTAIN AVE STE 3
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City | WESTFIELD
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State | NJ
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Zip | 07090-3152
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Country | US
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Telephone | 917-374-7977
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Fax |
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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 | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 16LP00014600
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 221700000X
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Taxonomy Name | Art Therapist
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License Number | 001169
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License Number State | NY
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