Provider Demographics
NPI:1518331651
Name:DAWN TREE NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Entity Type:Organization
Organization Name:DAWN TREE NURSE PRACTITIONER IN PSYCHIATRY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:R
Authorized Official - Last Name:TREE
Authorized Official - Suffix:
Authorized Official - Credentials:NPP
Authorized Official - Phone:845-594-8370
Mailing Address - Street 1:15 MILEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VERBANK
Mailing Address - State:NY
Mailing Address - Zip Code:12585-5023
Mailing Address - Country:US
Mailing Address - Phone:845-594-8370
Mailing Address - Fax:
Practice Address - Street 1:1133 ROUTE 55
Practice Address - Street 2:C/O ADVANCED CLINICIAN SUPPORT SERVICES, INC
Practice Address - City:LAGRANGEVILLE
Practice Address - State:NY
Practice Address - Zip Code:12540-5051
Practice Address - Country:US
Practice Address - Phone:845-594-8370
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-29
Last Update Date:2015-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY401679363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty