Provider Demographics
NPI:1073610747
Name:RECINOS, DAWNE (PSYD)
Entity Type:Individual
Prefix:
First Name:DAWNE
Middle Name:
Last Name:RECINOS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DAWNE
Other - Middle Name:
Other - Last Name:RECINOS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:578 WORTHINGTON RDG
Mailing Address - Street 2:
Mailing Address - City:BERLIN
Mailing Address - State:CT
Mailing Address - Zip Code:06037-2333
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:460 NEW BRITAIN RD
Practice Address - Street 2:SUITE #101
Practice Address - City:KENSINGTON
Practice Address - State:CT
Practice Address - Zip Code:06037-1323
Practice Address - Country:US
Practice Address - Phone:860-838-2068
Practice Address - Fax:860-838-2068
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-17
Last Update Date:2010-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002687103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT060002687CT01OtherANTHEM BC/BS
CT11565623OtherCAQH UNIVERSAL CREDENTIAL