Provider Demographics
NPI:1760669923
Name:SHEDRICK, DAWN ELAYNE (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:ELAYNE
Last Name:SHEDRICK
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 1:159 TWIN LAWNS AVE
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:NY
Mailing Address - Zip Code:11717-6019
Mailing Address - Country:US
Mailing Address - Phone:631-435-0106
Mailing Address - Fax:
Practice Address - Street 1:159 TWIN LAWNS AVE
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:NY
Practice Address - Zip Code:11717-6019
Practice Address - Country:US
Practice Address - Phone:631-231-4704
Practice Address - Fax:631-231-4704
Is Sole Proprietor?:No
Enumeration Date:2008-01-29
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0763841041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical