Healthcare Provider Details

I. General information

NPI: 1942845086
Provider Name (Legal Business Name): KATHLEEN DODGE LADC II
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2019
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 UNION ST
NEWBURYPORT MA
01950-3214
US

IV. Provider business mailing address

22 UNION ST
NEWBURYPORT MA
01950-3214
US

V. Phone/Fax

Practice location:
  • Phone: 508-574-7131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number18541
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: