Active NPI
Debra Lee Dodge
- Clinical Social Worker
- Medway, MA
National Provider Identifier
1063996486
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 114561
- Practice address
- 88 Summer St
Medway, MA 02053-2383 - Phone
- (508) 533-6643
- NPI assigned
- Sep 21, 2018
- Last updated
- Sep 21, 2018
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | 114561 | MA | Primary |
Addresses
Primary practice location
88 Summer St
Medway, MA 02053-2383
Mailing address
406 Pakachoag St
Auburn, MA 01501-2425
Phone (508) 517-1058
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 22 | Medicaid | MA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 114561 | MA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537488000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537488000000",
"number": "1063996486",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "406 PAKACHOAG ST",
"city": "AUBURN",
"state": "MA",
"postal_code": "015012425",
"telephone_number": "508-517-1058"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "88 SUMMER ST",
"city": "MEDWAY",
"state": "MA",
"postal_code": "020532383",
"telephone_number": "508-533-6643"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DODGE",
"first_name": "DEBRA",
"middle_name": "LEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-21",
"last_updated": "2018-09-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "MA",
"license": "114561",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "22",
"state": "MA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Medway, MA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.