Provider Demographics
NPI:1992035497
Name:DAWSON, IRENE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:IRENE
Middle Name:
Last Name:DAWSON
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 1:119 CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:SEA CLIFF
Mailing Address - State:NY
Mailing Address - Zip Code:11579-1531
Mailing Address - Country:US
Mailing Address - Phone:516-532-3663
Mailing Address - Fax:
Practice Address - Street 1:267 SEA CLIFF AVE
Practice Address - Street 2:SUITE 5
Practice Address - City:SEA CLIFF
Practice Address - State:NY
Practice Address - Zip Code:11579-1253
Practice Address - Country:US
Practice Address - Phone:516-532-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-05
Last Update Date:2014-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0817121041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA300108632Medicare PIN