Provider Demographics
NPI:1558541011
Name:MAGUIRE, DAWN MARIE (LICSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:MAGUIRE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 SNOWBERRY CT
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02917-4000
Mailing Address - Country:US
Mailing Address - Phone:401-286-1917
Mailing Address - Fax:866-899-3402
Practice Address - Street 1:640 GEORGE WASHINGTON HWY STE
Practice Address - Street 2:BDG B, STE 103
Practice Address - City:LINCOLN
Practice Address - State:RI
Practice Address - Zip Code:02865
Practice Address - Country:US
Practice Address - Phone:401-286-1917
Practice Address - Fax:866-899-3402
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2020-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW022981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI42-1765759OtherEIN