MEDICARE: MRS. DAWN MARIE DIGENNARO LMSW

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	12729	SC
2	1041C0700X	Clinical Social Worker	055818	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	055818	OTHER	NY	LICENSE

General Provider Information

NPI Number	:	1174712574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. DAWN MARIE DIGENNARO LMSW

Provider Business Mailing Address
First Line	:	1808 ROUTE 6
Second Line	:
City	:	CARMEL
State	:	NY
Zip	:	10512-2356
Country	:	US
Telephone Number	:	845-225-2700
Fax Number	:	845-225-3207

Provider Business Practice Location Address
First Line	:	1101 OLD TROLLEY RD STE 400
Second Line	:
City	:	SUMMERVILLE
State	:	SC
Zip	:	29485-5294
Country	:	US
Telephone Number	:	843-695-7106
Fax Number	:	833-672-3082

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

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/31/2023

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