Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003072745 |
---|---|
Provider Name | Dawn M Vincent |
First Address | West Yarmouth, MA 02673-1417 |
Second Address | Falmouth, MA 02540-2525 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2008 |
Last Update Date | 01/08/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1306723 | (05) | MA |
1310518 | (05) | MA |