Provider Demographics
NPI:1689496499
Name:DODGE, KAREN CHRISTINE (PHD, MSPH, LCSW)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:CHRISTINE
Last Name:DODGE
Suffix:
Gender:F
Credentials:PHD, MSPH, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 TURNBERRY DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIS
Mailing Address - State:FL
Mailing Address - Zip Code:33462-1023
Mailing Address - Country:US
Mailing Address - Phone:561-478-3814
Mailing Address - Fax:
Practice Address - Street 1:1405 SE GOLDTREE DR
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-7563
Practice Address - Country:US
Practice Address - Phone:561-346-0660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-31
Last Update Date:2024-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL171021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical