Provider Demographics
NPI:1467705475
Name:PALUMBO-MADERA, DAWN MARIE (LMHC, CAP, NCC)
Entity Type:Individual
Prefix:MS
First Name:DAWN
Middle Name:MARIE
Last Name:PALUMBO-MADERA
Suffix:
Gender:F
Credentials:LMHC, CAP, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12094 ANDERSON RD # 137
Mailing Address - Street 2:
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33625-5682
Mailing Address - Country:US
Mailing Address - Phone:813-220-5377
Mailing Address - Fax:
Practice Address - Street 1:10516 WINROCK PL
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33624-5126
Practice Address - Country:US
Practice Address - Phone:813-993-2444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-16
Last Update Date:2023-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH15577101Y00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1467705475Medicaid
FL1467705475Medicaid
FL1467705475Medicare Oscar/Certification
FL1467705475Medicare PIN
FL1467705475Medicare NSC