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General NPI Number Information
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NPI Number | 1245844307
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Entity Type | Individual
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Provider Name | SOPHIA CANDIDA FERREIRA DODGE PH.D., LP, NCSP
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Gender | Female
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Dates
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Enumeration Date | 09/04/2020
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Last Update Date | 04/13/2025
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Provider Practice Location Address
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Address Line | 401 GRAND AVE
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City | OAKLAND
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State | CA
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Zip | 94610-5054
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Country | US
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Telephone | 510-394-2240
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Fax | 510-394-1967
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Provider Business Mailing Address
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Address Line | 401 GRAND AVE
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City | OAKLAND
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State | CA
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Zip | 94610-5054
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Country | US
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Telephone | 510-394-2240
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Fax | 510-394-1967
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 5132-57
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License Number State | WI
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