Basic Information
| Provider Information | |||||||||
| NPI: | 1033123641 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | PICOTTE | ||||||||
| FirstName: | DAWN | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2147 | ||||||||
| Address2: | |||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339022147 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393432062 | ||||||||
| FaxNumber: | 2394244186 | ||||||||
| Practice Location | |||||||||
| Address1: | 12550 NEW BRITTANY BLVD | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339073655 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2393439190 | ||||||||
| FaxNumber: | 2393439193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2006 | ||||||||
| LastUpdateDate: | 03/29/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/29/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | MD09177 | RI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry | 2084P0804X | MD09177 | RI | N | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry | 2084P0804X | ME112295 | FL | Y | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Child & Adolescent Psychiatry |
ID Information
| ID | Type | State | Issuer | Description | 15-36801 | 01 | RI | UNITED BEHAVIORAL HEALTH | OTHER | 400245 | 01 | RI | BLUE CHIP | OTHER | 1104801349 | 01 | BUTLER HOSPITAL NPI | OTHER | 25184-8 | 01 | RI | BLUE CROSS | OTHER | 006741700 | 05 | FL | MEDICAID | 1093831646 | 01 | BUTLER HOSPITAL PROFESSIONAL BILLING OFFICE NPI | OTHER | 9025184 | 05 | RI | MEDICAID |