Provider Demographics
NPI:1962761049
Name:DAWN A GONSALVES MD PSYCHIATRY PLLC
Entity type:Organization
Organization Name:DAWN A GONSALVES MD PSYCHIATRY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DAWN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GONSALVES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:646-541-2449
Mailing Address - Street 1:187 E MARKET ST
Mailing Address - Street 2:SUITE # P-800
Mailing Address - City:RHINEBECK
Mailing Address - State:NY
Mailing Address - Zip Code:12572-1727
Mailing Address - Country:US
Mailing Address - Phone:646-541-2449
Mailing Address - Fax:845-340-7314
Practice Address - Street 1:187 E MARKET ST
Practice Address - Street 2:SUITE # P-800
Practice Address - City:RHINEBECK
Practice Address - State:NY
Practice Address - Zip Code:12572-1727
Practice Address - Country:US
Practice Address - Phone:646-541-2449
Practice Address - Fax:845-340-7314
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-10
Last Update Date:2012-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2438272084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty