Provider Demographics
NPI:1558440214
Name:EGO, DAWN (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:EGO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 WINTHROP ST
Mailing Address - Street 2:
Mailing Address - City:AUGUSTA
Mailing Address - State:ME
Mailing Address - Zip Code:04330-5624
Mailing Address - Country:US
Mailing Address - Phone:207-626-3448
Mailing Address - Fax:207-626-3453
Practice Address - Street 1:32 WINTHROP ST
Practice Address - Street 2:
Practice Address - City:AUGUSTA
Practice Address - State:ME
Practice Address - Zip Code:04330-5624
Practice Address - Country:US
Practice Address - Phone:207-626-3448
Practice Address - Fax:207-626-3453
Is Sole Proprietor?:No
Enumeration Date:2006-11-03
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC105031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical