Provider Demographics
NPI:1508896580
Name:DODGE, CYNTHIA E (PSYD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:E
Last Name:DODGE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BETHESDA DR
Mailing Address - Street 2:SUITE # 4
Mailing Address - City:HORNELL
Mailing Address - State:NY
Mailing Address - Zip Code:14843-1018
Mailing Address - Country:US
Mailing Address - Phone:607-324-9240
Mailing Address - Fax:
Practice Address - Street 1:2 BETHESDA DR
Practice Address - Street 2:SUITE # 4
Practice Address - City:HORNELL
Practice Address - State:NY
Practice Address - Zip Code:14843-1018
Practice Address - Country:US
Practice Address - Phone:607-324-9240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015861-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical