Provider Demographics
NPI:1659512440
Name:CISEWSKI, DAWN MARIE (PSYD)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:CISEWSKI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:REDONDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:155 MAPLE ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01105-1828
Mailing Address - Country:US
Mailing Address - Phone:413-734-3331
Mailing Address - Fax:413-739-1652
Practice Address - Street 1:155 MAPLE ST
Practice Address - Street 2:SUITE 203
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01105-1828
Practice Address - Country:US
Practice Address - Phone:413-734-3331
Practice Address - Fax:413-739-1652
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2013-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8187103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical