Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 9406 | FL |
N | 103TC0700X | Clinical Psychologist | 9406 | FL |
Y | 103G00000X | Clinical Psychologist | PY9406 | FL |
Y | 103TC0700X | Clinical Psychologist | PY9406 | FL |
N | 103TR0400X | Rehabilitation Psychologist | 9406 | FL |
NPI | 1154652030 |
---|---|
Provider Name | Casey Jennifer Dawson |
First Address | Miramar, FL 33025-3925 |
Second Address | Hollywood, FL 33021-8216 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/01/2010 |
Last Update Date | 18/03/2021 |