Provider Demographics
NPI:1134690217
Name:DODT, SHELLEY ANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:ANNE
Last Name:DODT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2539 SW GREENWICH WAY
Mailing Address - Street 2:
Mailing Address - City:PALM CITY
Mailing Address - State:FL
Mailing Address - Zip Code:34990-7504
Mailing Address - Country:US
Mailing Address - Phone:772-631-3704
Mailing Address - Fax:
Practice Address - Street 1:2539 SW GREENWICH WAY
Practice Address - Street 2:
Practice Address - City:PALM CITY
Practice Address - State:FL
Practice Address - Zip Code:34990-7504
Practice Address - Country:US
Practice Address - Phone:772-631-3704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-16
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW159161041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty