Provider Demographics
NPI:1245261254
Name:DORCAS, DAWN ANNE (LCSW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:ANNE
Last Name:DORCAS
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:PO BOX 429
Mailing Address - Street 2:
Mailing Address - City:ROSCOE
Mailing Address - State:NY
Mailing Address - Zip Code:12776-0429
Mailing Address - Country:US
Mailing Address - Phone:607-498-4126
Mailing Address - Fax:
Practice Address - Street 1:6 ACADEMY ST
Practice Address - Street 2:
Practice Address - City:ROSCOE
Practice Address - State:NY
Practice Address - Zip Code:12776-5300
Practice Address - Country:US
Practice Address - Phone:607-498-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0761001041C0700X
NY11489211041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00398370Medicaid