Provider Demographics
NPI:1841390382
Name:CHRISTENSEN, DAWN ERIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAWN
Middle Name:ERIN
Last Name:CHRISTENSEN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:D. ERIN
Other - Middle Name:
Other - Last Name:CHRISTENSEN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:PO BOX 625
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33836-0625
Mailing Address - Country:US
Mailing Address - Phone:603-344-1819
Mailing Address - Fax:863-353-6081
Practice Address - Street 1:410 LAKE DAVENPORT CIR
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:FL
Practice Address - Zip Code:33837-7530
Practice Address - Country:US
Practice Address - Phone:603-344-1819
Practice Address - Fax:863-353-6081
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH847103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH06Y008613NH01OtherNH BC/BS PROVIDER ID
NH30423735Medicaid