Healthcare Provider Details

I. General information

NPI: 1467368837
Provider Name (Legal Business Name): JACKLYN ELIZABETH DODSON LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1023 STATE ST
SCHENECTADY NY
12307-1511
US

IV. Provider business mailing address

1311 CYPRIANA TER
SCHENECTADY NY
12306-2553
US

V. Phone/Fax

Practice location:
  • Phone: 518-831-8700
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number133077
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: