Provider Demographics
NPI:1083865240
Name:BRENNAN TESORO, DAWN MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:BRENNAN TESORO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:BRENNAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:AMITYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11701-0066
Mailing Address - Country:US
Mailing Address - Phone:631-235-9901
Mailing Address - Fax:
Practice Address - Street 1:201 DIXON AVE
Practice Address - Street 2:
Practice Address - City:AMITYVILLE
Practice Address - State:NY
Practice Address - Zip Code:11701-2832
Practice Address - Country:US
Practice Address - Phone:631-782-6503
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2008-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0659081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical