Provider Demographics
NPI:1154652030
Name:DAWSON, CASEY JENNIFER (PHD)
Entity Type:Individual
Prefix:
First Name:CASEY
Middle Name:JENNIFER
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:CASEY
Other - Middle Name:JENNIFER
Other - Last Name:HADDAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2900 CORPORATE WAY
Mailing Address - Street 2:DOOR D
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-3925
Mailing Address - Country:US
Mailing Address - Phone:954-276-5685
Mailing Address - Fax:954-985-7074
Practice Address - Street 1:3600 WASHINGTON ST STE 1005
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33021-8216
Practice Address - Country:US
Practice Address - Phone:954-518-5507
Practice Address - Fax:954-981-3476
Is Sole Proprietor?:No
Enumeration Date:2010-01-16
Last Update Date:2021-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL9406103TR0400X, 103G00000X
FLPY9406103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist