Healthcare Provider Details

I. General information

NPI: 1205144516
Provider Name (Legal Business Name): JENNIFER ZODAN-DODDS PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/21/2010
Last Update Date: 07/01/2021
Certification Date: 07/01/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2234 JACKSON AVE STE 205
SEAFORD NY
11783-2600
US

IV. Provider business mailing address

2234 JACKSON AVE STE 205
SEAFORD NY
11783-2600
US

V. Phone/Fax

Practice location:
  • Phone: 516-695-9540
  • Fax:
Mailing address:
  • Phone: 516-695-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number019714
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberP77810
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: