Provider Demographics
NPI:1871728113
Name:DODD, KASANDRA LYNETTE (LICSW)
Entity type:Individual
Prefix:
First Name:KASANDRA
Middle Name:LYNETTE
Last Name:DODD
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2506 MARKHAM LN APT 3
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2665
Mailing Address - Country:US
Mailing Address - Phone:301-772-6071
Mailing Address - Fax:
Practice Address - Street 1:2506 MARKHAM LN APT 3
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-2665
Practice Address - Country:US
Practice Address - Phone:301-772-6071
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-15
Last Update Date:2009-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500782651041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical