1073610747 NPI number — DAWNE RECINOS PSY.D.

Table of content: DAWNE RECINOS PSY.D. (NPI 1073610747)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073610747 NPI number — DAWNE RECINOS PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RECINOS
Provider First Name:
DAWNE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
RECINOS
Provider Other First Name:
DAWNE
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
2

NPI Number Information

NPI Number:
1073610747
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/09/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
578 WORTHINGTON RDG
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BERLIN
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06037-2333
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
460 NEW BRITAIN RD
Provider Second Line Business Practice Location Address:
SUITE #101
Provider Business Practice Location Address City Name:
KENSINGTON
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06037-1323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-838-2068
Provider Business Practice Location Address Fax Number:
860-838-2068
Provider Enumeration Date:
09/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  002687 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 060002687CT01 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 11565623 . This is a "CAQH UNIVERSAL CREDENTIAL" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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