Provider Demographics
NPI:1598860652
Name:KOKERNAK, DAWN (MSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:
Last Name:KOKERNAK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 BOURNE DR
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NH
Mailing Address - Zip Code:03110-6849
Mailing Address - Country:US
Mailing Address - Phone:603-472-5117
Mailing Address - Fax:
Practice Address - Street 1:120 BEDFORD CENTER RD
Practice Address - Street 2:STE. 302
Practice Address - City:BEDFORD
Practice Address - State:NH
Practice Address - Zip Code:03110-5442
Practice Address - Country:US
Practice Address - Phone:603-472-5117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH1400567Y0NH01OtherANTHEM BLUE CROSS BLUE SH
RE2670Medicare ID - Type Unspecified