Provider Demographics
NPI:1649831033
Name:DAWSON, MARY BERNADETTE (COMS, MED)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:BERNADETTE
Last Name:DAWSON
Suffix:
Gender:F
Credentials:COMS, MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PHEASANT DR
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02920-1315
Mailing Address - Country:US
Mailing Address - Phone:781-254-6947
Mailing Address - Fax:
Practice Address - Street 1:11 PHEASANT DR
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02920-1315
Practice Address - Country:US
Practice Address - Phone:781-254-6947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-26
Last Update Date:2022-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225CX0006XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorOrientation and Mobility Training ProviderGroup - Single Specialty