Provider Demographics
NPI:1780730747
Name:BURNS CASEY, DAWN DENISE (LCSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:DENISE
Last Name:BURNS CASEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:DAWN
Other - Middle Name:DENISE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1573 SEA ISLE RD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-6951
Mailing Address - Country:US
Mailing Address - Phone:901-685-6149
Mailing Address - Fax:
Practice Address - Street 1:5600 GOODMAN RD STE B
Practice Address - Street 2:
Practice Address - City:OLIVE BRANCH
Practice Address - State:MS
Practice Address - Zip Code:38654-7002
Practice Address - Country:US
Practice Address - Phone:901-218-8117
Practice Address - Fax:662-893-1102
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLSW00000044931041C0700X
MSC59631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09207046Medicaid
TN3987298Medicare ID - Type UnspecifiedMEDICARE