MEDICARE: STURGES DODGE, LCSW, P.A.

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	Q1-0000576	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	218529	OTHER	DE	COMPSYCH CORP.
2	100023371002	OTHER	DE	APS HEALTHCARE
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	3348967	OTHER	DE	AETNA HEALTH MANAGEMENT
5	62-98635	OTHER	DE	UNITED HEALTHCARE

General Provider Information

NPI Number	:	1326175613
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	STURGES DODGE, LCSW, P.A.

Provider Business Mailing Address
First Line	:	512 NEW CASTLE STREET EXTENDED
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-1839
Country	:	US
Telephone Number	:	302-227-1446
Fax Number	:	302-227-1446

Provider Business Practice Location Address
First Line	:	512 NEW CASTLE STREET EXTENDED
Second Line	:
City	:	REHOBOTH BEACH
State	:	DE
Zip	:	19971-1839
Country	:	US
Telephone Number	:	302-227-1446
Fax Number	:	302-227-1446

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. MARY STURGES DODGE
Credential	:	LCSW
Telephone Number	:	302-227-1446

Provider Enumeration Date	:	02/27/2007
Last Update Date	:	08/22/2020

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