Provider Demographics
NPI:1518016724
Name:RODWELL, DOROTHY LENA (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:DOROTHY
Middle Name:LENA
Last Name:RODWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:LENA
Other - Last Name:ROBINSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:190 TROPICAL SHORE WAY
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33931-3316
Mailing Address - Country:US
Mailing Address - Phone:239-851-7166
Mailing Address - Fax:
Practice Address - Street 1:15641 NEW HAMPSHIRE CT
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4123
Practice Address - Country:US
Practice Address - Phone:239-851-7166
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
FLMT1990106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ072BOtherBLUE CROSS BLUE SHIELD FL
FL251916366OtherTRICARE