Provider Demographics
NPI:1396813846
Name:PATTERSON, DAWN M (LICSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:M
Last Name:PATTERSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:495 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-1007
Mailing Address - Country:US
Mailing Address - Phone:617-783-0500
Mailing Address - Fax:617-783-5514
Practice Address - Street 1:287 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:ALLSTON
Practice Address - State:MA
Practice Address - Zip Code:02134-1010
Practice Address - Country:US
Practice Address - Phone:617-783-0500
Practice Address - Fax:617-783-5514
Is Sole Proprietor?:No
Enumeration Date:2006-12-01
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10202301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1320882Medicaid
MA1301446Medicaid
MA221861Medicare ID - Type UnspecifiedMEDICARE WA
MA1301446Medicaid