Provider Demographics
NPI:1952066615
Name:COFFMAN, DAWN MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:COFFMAN
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 1:22883 COUNTY ROUTE 69
Mailing Address - Street 2:
Mailing Address - City:RODMAN
Mailing Address - State:NY
Mailing Address - Zip Code:13682-2155
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:650 STATE STREET
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-1251
Practice Address - Country:US
Practice Address - Phone:315-755-1251
Practice Address - Fax:315-291-6601
Is Sole Proprietor?:No
Enumeration Date:2021-11-07
Last Update Date:2023-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVBP00945432101YM0800X
112305104100000X
NY0961681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker