Provider Demographics
NPI:1396407177
Name:DAWSON-GLOBUS, MICHAELENE ROSE
Entity Type:Individual
Prefix:
First Name:MICHAELENE
Middle Name:ROSE
Last Name:DAWSON-GLOBUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1391 GLIDDEN CIR
Mailing Address - Street 2:
Mailing Address - City:DERBY
Mailing Address - State:NY
Mailing Address - Zip Code:14047-9678
Mailing Address - Country:US
Mailing Address - Phone:716-359-3208
Mailing Address - Fax:
Practice Address - Street 1:2829 WEHRLE DR STE 12A
Practice Address - Street 2:
Practice Address - City:WILLIAMSVILLE
Practice Address - State:NY
Practice Address - Zip Code:14221-7387
Practice Address - Country:US
Practice Address - Phone:716-359-3208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-09
Last Update Date:2021-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical