1326175613 NPI number — STURGES DODGE, LCSW, P.A.

Table of content: (NPI 1326175613)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326175613 NPI number — STURGES DODGE, LCSW, P.A.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
STURGES DODGE, LCSW, P.A.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1326175613
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
512 NEW CASTLE STREET EXTENDED
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
REHOBOTH BEACH
Provider Business Mailing Address State Name:
DE
Provider Business Mailing Address Postal Code:
19971-1839
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
302-227-1446
Provider Business Mailing Address Fax Number:
302-227-1446

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
512 NEW CASTLE STREET EXTENDED
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
REHOBOTH BEACH
Provider Business Practice Location Address State Name:
DE
Provider Business Practice Location Address Postal Code:
19971-1839
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
302-227-1446
Provider Business Practice Location Address Fax Number:
302-227-1446
Provider Enumeration Date:
02/27/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DODGE
Authorized Official First Name:
MARY
Authorized Official Middle Name:
STURGES
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
302-227-1446

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  Q1-0000576 , registered in the state of DE ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 218529 . This is a "COMPSYCH CORP." identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 100023371002 . This is a "APS HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 1000023569 , issued by the state of ( DE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3348967 . This is a "AETNA HEALTH MANAGEMENT" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".
  • Identifier: 62-98635 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( DE ) . This identifiers is of the category "OTHER".




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