Provider Demographics
NPI:1528395092
Name:STAS, DAWN M (BA)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:M
Last Name:STAS
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 COURT ST
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02360-7304
Mailing Address - Country:US
Mailing Address - Phone:508-830-3444
Mailing Address - Fax:508-746-3944
Practice Address - Street 1:385 COURT ST
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02360-7304
Practice Address - Country:US
Practice Address - Phone:508-830-3444
Practice Address - Fax:508-746-3944
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-04
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health