Provider Demographics
NPI:1548444961
Name:MACNUTT, DAWN M (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:DAWN
Middle Name:M
Last Name:MACNUTT
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 HAT SHOP HILL ROAD
Mailing Address - Street 2:BOX 26
Mailing Address - City:BRIDGEWATER
Mailing Address - State:CT
Mailing Address - Zip Code:06752
Mailing Address - Country:US
Mailing Address - Phone:860-354-1348
Mailing Address - Fax:860-354-0555
Practice Address - Street 1:34 HAT SHOP HILL RD
Practice Address - Street 2:BOX 26
Practice Address - City:BRIDGEWATER
Practice Address - State:CT
Practice Address - Zip Code:06752
Practice Address - Country:US
Practice Address - Phone:860-354-1348
Practice Address - Fax:860-354-0555
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2007-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR038848-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical