Provider Demographics
NPI:1134778541
Name:LOCHAN DODD, AUSTIN ALBERT (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:AUSTIN
Middle Name:ALBERT
Last Name:LOCHAN DODD
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:AUSTIN
Other - Middle Name:ALBERT
Other - Last Name:DODD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BA
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01613-1165
Mailing Address - Country:US
Mailing Address - Phone:774-314-2320
Mailing Address - Fax:
Practice Address - Street 1:29 E MOUNTAIN ST
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01606-1400
Practice Address - Country:US
Practice Address - Phone:508-755-0556
Practice Address - Fax:508-853-1308
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2021-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 171M00000X
MA226931104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator