1447298153 NPI number — MR. WILLIAM CLARK DAWBER LICSW

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447298153 NPI number — MR. WILLIAM CLARK DAWBER LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DAWBER
Provider First Name:
WILLIAM
Provider Middle Name:
CLARK
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LICSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1447298153
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
15 CEDAR CREST LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SCITUATE
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02066-4501
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-545-5264
Provider Business Mailing Address Fax Number:
720-834-0617

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
15 CEDAR CREST LN
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SCITUATE
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02066-4501
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-545-5264
Provider Business Practice Location Address Fax Number:
720-834-0617
Provider Enumeration Date:
06/03/2006

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: 101YM0800X , with the licence number:  LICSW 100181 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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