Provider Demographics
NPI:1164555488
Name:DAWSON, JOAN K (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JOAN
Middle Name:K
Last Name:DAWSON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:764 CORALTREE LN APT 254
Mailing Address - Street 2:
Mailing Address - City:OAK PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91377-5450
Mailing Address - Country:US
Mailing Address - Phone:818-324-8390
Mailing Address - Fax:
Practice Address - Street 1:31824 VILLAGE CENTER RD
Practice Address - Street 2:SUITE E
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91361-4337
Practice Address - Country:US
Practice Address - Phone:818-991-1063
Practice Address - Fax:818-991-1064
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20943103TC0700X
CARN211395363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASTI1422OtherPSYCHOLOGIST