Provider Demographics
NPI:1174712574
Name:DIGENNARO, DAWN MARIE (LMSW)
Entity type:Individual
Prefix:MRS
First Name:DAWN
Middle Name:MARIE
Last Name:DIGENNARO
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MISS
Other - First Name:DAWN
Other - Middle Name:MARIE
Other - Last Name:WISSING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:1808 ROUTE 6
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:NY
Mailing Address - Zip Code:10512-2356
Mailing Address - Country:US
Mailing Address - Phone:845-225-2700
Mailing Address - Fax:845-225-3207
Practice Address - Street 1:1101 OLD TROLLEY RD STE 400
Practice Address - Street 2:
Practice Address - City:SUMMERVILLE
Practice Address - State:SC
Practice Address - Zip Code:29485-5294
Practice Address - Country:US
Practice Address - Phone:843-695-7106
Practice Address - Fax:833-672-3082
Is Sole Proprietor?:No
Enumeration Date:2007-10-22
Last Update Date:2023-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC127291041C0700X
NY0558181041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY055818OtherLICENSE