Provider Demographics
NPI:1689682387
Name:DODD, PHYLLIS YVONNE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:YVONNE
Last Name:DODD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:P.
Other - Middle Name:YVONNE
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:133 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19950-2178
Mailing Address - Country:US
Mailing Address - Phone:302-398-6471
Mailing Address - Fax:302-856-2196
Practice Address - Street 1:504 W. MARKET STREET
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947-1850
Practice Address - Country:US
Practice Address - Phone:302-855-0558
Practice Address - Fax:773-829-0558
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00007551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical