Healthcare Provider Details

I. General information

NPI: 1144365883
Provider Name (Legal Business Name): CECELIA LORI DODSON MARTINEZ SCHOOL PSYCHOLOGIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/20/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2034 S LINDSAY RD SOUTH VALLEY JUNIOR HIGH
GILBERT AZ
85296
US

IV. Provider business mailing address

140 S GILBERT ROAD GILBERT PUBLIC SCHOOLS MEDICAID SBCP
GILBERT AZ
85296
US

V. Phone/Fax

Practice location:
  • Phone: 480-855-0015
  • Fax: 480-855-3542
Mailing address:
  • Phone: 480-545-3826
  • Fax: 480-813-5974

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License NumberD04598197
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: