Provider Demographics
NPI:1225852023
Name:TETRO, DAWN (LCSW)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:
Last Name:TETRO
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 1:12 BLACKBURN KNL
Mailing Address - Street 2:
Mailing Address - City:SPENCERPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14559-2199
Mailing Address - Country:US
Mailing Address - Phone:585-224-6066
Mailing Address - Fax:
Practice Address - Street 1:12 BLACKBURN KNL
Practice Address - Street 2:
Practice Address - City:SPENCERPORT
Practice Address - State:NY
Practice Address - Zip Code:14559-2199
Practice Address - Country:US
Practice Address - Phone:585-224-6066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-09
Last Update Date:2024-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0813871041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical