Provider Demographics
NPI:1700407905
Name:DAHM, MADISON MCNALLY (MSW, LCSW)
Entity Type:Individual
Prefix:
First Name:MADISON
Middle Name:MCNALLY
Last Name:DAHM
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:MADISON
Other - Middle Name:LEIGH
Other - Last Name:MCNALLY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:39 MACHT RD
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:CT
Mailing Address - Zip Code:06237-1109
Mailing Address - Country:US
Mailing Address - Phone:860-334-3888
Mailing Address - Fax:
Practice Address - Street 1:5 FOUNDERS ST STE 100
Practice Address - Street 2:
Practice Address - City:WILLIMANTIC
Practice Address - State:CT
Practice Address - Zip Code:06226-2049
Practice Address - Country:US
Practice Address - Phone:860-423-9764
Practice Address - Fax:860-423-3115
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT103271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical