MEDICARE: VICTORIA DODGE

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	101YM0800X	Mental Health Counselor		NY

General Provider Information

NPI Number	:	1720561319
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VICTORIA DODGE

Provider Business Mailing Address
First Line	:	845 CENTRAL AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1514
Country	:	US
Telephone Number	:	518-729-3953
Fax Number	:

Provider Business Practice Location Address
First Line	:	845 CENTRAL AVE
Second Line	:
City	:	ALBANY
State	:	NY
Zip	:	12206-1514
Country	:	US
Telephone Number	:	518-729-3953
Fax Number	:

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

Provider Enumeration Date	:	09/11/2018
Last Update Date	:	01/14/2026

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Directions to “ VICTORIA DODGE ” Practice Location

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