MEDICARE: STEPHEN DAWSON

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	106H00000X	Marriage & Family Therapist	MT 3087	FL

General Provider Information

NPI Number	:	1285912279
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN DAWSON

Provider Business Mailing Address
First Line	:	1040 BAYVIEW DR
Second Line	:	101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-204-4123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 BAYVIEW DR
Second Line	:	101
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33304-2522
Country	:	US
Telephone Number	:	954-204-4123
Fax Number	:

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

Provider Enumeration Date	:	07/26/2011
Last Update Date	:	04/06/2017

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