Provider Demographics
NPI:1326598871
Name:DODDS, ERIS
Entity Type:Individual
Prefix:
First Name:ERIS
Middle Name:
Last Name:DODDS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 MANSFIELD HOLLOW RD.
Mailing Address - Street 2:APT 5
Mailing Address - City:MANSFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06250
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1325 S STATE ST
Practice Address - Street 2:
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19901-4945
Practice Address - Country:US
Practice Address - Phone:302-244-3404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-08
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11936660103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst