Healthcare Provider Details

I. General information

NPI: 1730967134
Provider Name (Legal Business Name): ALEXANDRA MAE DODGE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2023
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 DISTRICT AVE STE 520
BURLINGTON MA
01803-5060
US

IV. Provider business mailing address

12 SPENCER ST
STONEHAM MA
02180-2616
US

V. Phone/Fax

Practice location:
  • Phone: 978-886-2739
  • Fax:
Mailing address:
  • Phone: 978-886-2739
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number1142904
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: