Kenneth Bart Dodson
Individual provider Active NPI Clinical Social Worker · Farmington, NM
NPI 1194013490 · NPPES record last updated Apr 3, 2025
Key facts
- NPI
- 1194013490
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- C09762 (NM)
- Practice address
- 2001 N Cochiti Ave
Farmington, NM 87401-4237 - Phone
- (505) 613-6909
- NPI assigned
- Jul 20, 2011
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0139981 | NM | MD | Addiction (Substance Use Disorder) Counselor |
| C09762 | NM | MD | Clinical Social Worker |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Sequoia Counseling Inc. | Clinical | Current |
Accepting new patients |
Locations
2001 N Cochiti Ave
Farmington, NM 87401
Phone (505) 592-3055
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Addiction (Substance Use Disorder) Counselor | 101YA0400X | 0139981 | NM | |
| Clinical Social Worker | 1041C0700X | C09762 | NM | Yes |
Addresses
Primary practice location
2001 N Cochiti Ave
Farmington, NM 87401-4237
Mailing address
PO Box 322
Farmington, NM 87499-0322
Phone (505) 613-6909
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| N0001955 | Medicaid | NM |
Other providers in Farmington, NM
- Kyra Diffey
- Matthew Raleigh Difrancesca
- Devon Dillon
- Cameron Dobey
- Janet Dodson
- Crystal Hope Doerr
- Donald K. Glover, D.O., P.C.
- Donald R. Froyd, Jr., PH.D.
- Kami Lea Donald
- Jason S Doolin
All providers in Farmington, NM · Clinical Social Worker in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 3, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.