MEDICARE: MRS. AMANDA LEE DODD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904010173	VA

General Provider Information

NPI Number	:	1134635295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. AMANDA LEE DODD LCSW

Provider Business Mailing Address
First Line	:	5119 SPRING ASH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1827
Country	:	US
Telephone Number	:	856-371-9086
Fax Number	:

Provider Business Practice Location Address
First Line	:	5119 SPRING ASH
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78247-1827
Country	:	US
Telephone Number	:	856-371-9086
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/27/2017
Last Update Date	:	08/16/2023

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