Provider Demographics
NPI:1245844307
Name:DODGE, SOPHIA CANDIDA FERREIRA (PHD, LP, NCSP)
Entity type:Individual
Prefix:DR
First Name:SOPHIA
Middle Name:CANDIDA FERREIRA
Last Name:DODGE
Suffix:
Gender:F
Credentials:PHD, LP, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-5054
Mailing Address - Country:US
Mailing Address - Phone:510-394-2240
Mailing Address - Fax:510-394-1967
Practice Address - Street 1:401 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-5054
Practice Address - Country:US
Practice Address - Phone:510-394-2240
Practice Address - Fax:510-394-1967
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2025-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TS0200X
WI5132-57103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool