Provider Demographics
NPI:1619663945
Name:HODGSON, SIDNEY (MS)
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:HODGSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10300 SW 72ND ST STE 123
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33173-3001
Mailing Address - Country:US
Mailing Address - Phone:305-302-4776
Mailing Address - Fax:
Practice Address - Street 1:10300 SW 72ND ST STE 123
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-3001
Practice Address - Country:US
Practice Address - Phone:305-302-4776
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-11
Last Update Date:2023-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH21347101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health