Provider Demographics
NPI:1831662220
Name:IPPOLITI, DAWN GILBERT (MAMA, LCAT, LPAT)
Entity Type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:GILBERT
Last Name:IPPOLITI
Suffix:
Gender:F
Credentials:MAMA, LCAT, LPAT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 MOUNTAIN AVE STE 3
Mailing Address - Street 2:
Mailing Address - City:WESTFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07090-3152
Mailing Address - Country:US
Mailing Address - Phone:917-374-7977
Mailing Address - Fax:
Practice Address - Street 1:202 MOUNTAIN AVE STE 3
Practice Address - Street 2:
Practice Address - City:WESTFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07090-3152
Practice Address - Country:US
Practice Address - Phone:917-374-7977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-08
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ16LP00014600221700000X
NY001169221700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes221700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersArt Therapist