Provider Demographics
NPI:1275967762
Name:HODGES, CARMEN LYNN (PSYD, LCADC)
Entity Type:Individual
Prefix:DR
First Name:CARMEN
Middle Name:LYNN
Last Name:HODGES
Suffix:
Gender:F
Credentials:PSYD, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 BRADFORD AVE APT 13
Mailing Address - Street 2:
Mailing Address - City:TRENTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08610-3107
Mailing Address - Country:US
Mailing Address - Phone:609-638-7560
Mailing Address - Fax:
Practice Address - Street 1:17 BRADFORD AVE APT 13
Practice Address - Street 2:
Practice Address - City:TRENTON
Practice Address - State:NJ
Practice Address - Zip Code:08610-3107
Practice Address - Country:US
Practice Address - Phone:609-638-7560
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-03
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00069000101YA0400X
NJ35SI00496000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)