Provider Demographics
NPI:1831722123
Name:DAWSON, ERIC (LCSW, LICSW)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:DAWSON
Suffix:
Gender:M
Credentials:LCSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 LINNAEAN ST APT 1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1568
Mailing Address - Country:US
Mailing Address - Phone:989-600-1289
Mailing Address - Fax:
Practice Address - Street 1:75 MT AUBURN ST
Practice Address - Street 2:HARVARD UNIVERSITY HEALTH SERVICES
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138
Practice Address - Country:US
Practice Address - Phone:617-495-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-15
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0893811041C0700X
MA0001241761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000124176Medicaid