Provider Demographics
NPI:1144757691
Name:DAWN WYMAN LICSW PLLC
Entity Type:Organization
Organization Name:DAWN WYMAN LICSW PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEE
Authorized Official - Middle Name:
Authorized Official - Last Name:DIETER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-714-0870
Mailing Address - Street 1:PO BOX 4275
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03108-4275
Mailing Address - Country:US
Mailing Address - Phone:603-440-4519
Mailing Address - Fax:603-232-3079
Practice Address - Street 1:3 EXECUTIVE PARK DR STE 212
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-6975
Practice Address - Country:US
Practice Address - Phone:603-440-4519
Practice Address - Fax:603-232-3079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-15
Last Update Date:2017-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health