Provider Demographics
NPI:1033123641
Name:PICOTTE, DAWN MARIE (MD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:PICOTTE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2147
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33902-2147
Mailing Address - Country:US
Mailing Address - Phone:239-343-2062
Mailing Address - Fax:239-424-4186
Practice Address - Street 1:12550 NEW BRITTANY BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33907-3655
Practice Address - Country:US
Practice Address - Phone:239-343-9190
Practice Address - Fax:239-343-9193
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2021-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIMD091772084P0800X, 2084P0804X
FLME1122952084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI15-36801OtherUNITED BEHAVIORAL HEALTH
RI400245OtherBLUE CHIP
1104801349OtherBUTLER HOSPITAL NPI
RI25184-8OtherBLUE CROSS
FL006741700Medicaid
1093831646OtherBUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI
RI9025184Medicaid
RI269025184Medicare ID - Type Unspecified