Provider Demographics
NPI:1093829871
Name:ROY, DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:ROY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:
Other - Last Name:SUTTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 TUNXIS HILL RD
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06825-4412
Mailing Address - Country:US
Mailing Address - Phone:203-331-7458
Mailing Address - Fax:
Practice Address - Street 1:540 TUNXIS HILL RD
Practice Address - Street 2:1ST FLOOR
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06825-4412
Practice Address - Country:US
Practice Address - Phone:203-331-7458
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2011-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0042791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039244Medicaid
CT140004279CT01OtherANTHEM BCBS
CT191105OtherMANAGED HEALTH NETWORK
CT800004195Medicare PIN