Provider Demographics
NPI:1003583568
Name:DAWES, NICKKI P
Entity Type:Individual
Prefix:DR
First Name:NICKKI
Middle Name:P
Last Name:DAWES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 PAGE RD
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02460-1513
Mailing Address - Country:US
Mailing Address - Phone:217-766-6792
Mailing Address - Fax:
Practice Address - Street 1:765 COMMONWEALTH AVE
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02215-1401
Practice Address - Country:US
Practice Address - Phone:217-766-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist