| Dawn Wyman Licsw Pllc | |
|
3 Executive Park Dr Ste 212 Bedford NH 03110-6975 | |
| (603) 440-4519 | |
| (603) 232-3079 |
| Full Name | Dawn Wyman Licsw Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3 Executive Park Dr Ste 212, Bedford, New Hampshire |
| Authorized Official Name and Position | Lee Dieter (BILLING MANAGER) |
| Authorized Official Contact | 6037140870 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Dawn Wyman Licsw Pllc Po Box 4275 Manchester NH 03108-4275 Ph: (603) 440-4519 | Dawn Wyman Licsw Pllc 3 Executive Park Dr Ste 212 Bedford NH 03110-6975 Ph: (603) 440-4519 |
| NPI Number | 1144757691 |
|---|---|
| Provider Enumeration Date | 05/15/2017 |
| Last Update Date | 05/15/2017 |
| Medicare PECOS PAC ID | 8729356431 |
|---|---|
| Medicare Enrollment ID | O20170622000271 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1144757691 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0850X | Clinic/center - Adult Mental Health | (* (Not Available)) | Secondary |
| 261QM0855X | Clinic/center - Adolescent And Children Mental Health | (* (Not Available)) | Primary |
| Provider Name | Dawn R Wyman |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1134341241 PECOS PAC ID: 7911151790 Enrollment ID: I20130201000141 |
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