Healthcare Provider Details

I. General information

NPI: 1053203158
Provider Name (Legal Business Name): DODSON THERAPY ASSOCIATES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2025
Last Update Date: 07/15/2025
Certification Date: 07/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 BROADWAY STE N
ALBANY NY
12207-2922
US

IV. Provider business mailing address

6 N RIDGE RD
POMONA NY
10970-2111
US

V. Phone/Fax

Practice location:
  • Phone: 845-600-0969
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DOMINIQUE DODSON
Title or Position: FOUNDER, PSYCHOTHERAPIST
Credential:
Phone: 845-600-0969