Provider Demographics
NPI:1992413348
Name:REAGAN, DAWN MARIE (LMSW)
Entity type:Individual
Prefix:
First Name:DAWN
Middle Name:MARIE
Last Name:REAGAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 HAMILTON AVE
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1610
Mailing Address - Country:US
Mailing Address - Phone:718-924-2618
Mailing Address - Fax:
Practice Address - Street 1:105 HAMILTON AVE
Practice Address - Street 2:
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1610
Practice Address - Country:US
Practice Address - Phone:718-688-1602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117668-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker