MEDICARE: DAWN GLASCO LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	44SC05442300	NJ

General Provider Information

NPI Number	:	1093004624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN GLASCO LCSW

Provider Business Mailing Address
First Line	:	505 SOUTH AVE E
Second Line	:
City	:	CRANFORD
State	:	NJ
Zip	:	07016-3246
Country	:	US
Telephone Number	:	908-497-3946
Fax Number	:	201-333-4211

Provider Business Practice Location Address
First Line	:	590 NORTH 7TH STREET
Second Line	:
City	:	NEWARK
State	:	NJ
Zip	:	07102-2522
Country	:	US
Telephone Number	:	908-644-9764
Fax Number	:	201-333-4211

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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