Provider Demographics
NPI:1548398472
Name:DADES, DAWN NICOLI (MFT)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:NICOLI
Last Name:DADES
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:985 KENDALL DR
Mailing Address - Street 2:UNIT 283
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-4315
Mailing Address - Country:US
Mailing Address - Phone:626-974-1822
Mailing Address - Fax:626-974-8198
Practice Address - Street 1:508 S 2ND AVE
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91723-3012
Practice Address - Country:US
Practice Address - Phone:626-974-8122
Practice Address - Fax:626-974-8198
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2011-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC29487106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist