Provider Demographics
NPI:1942546551
Name:DODD, PATTRA FARTHING (LCSW)
Entity Type:Individual
Prefix:
First Name:PATTRA
Middle Name:FARTHING
Last Name:DODD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 25TH ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34947-4711
Mailing Address - Country:US
Mailing Address - Phone:772-595-5150
Mailing Address - Fax:772-595-6560
Practice Address - Street 1:1901 S 25TH ST
Practice Address - Street 2:SUITE 103
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34947-4711
Practice Address - Country:US
Practice Address - Phone:772-595-5150
Practice Address - Fax:772-595-6560
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-31
Last Update Date:2014-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health