Provider Demographics
NPI:1801919618
Name:BIRD, DODNNA LEE (LCSW)
Entity type:Individual
Prefix:
First Name:DODNNA
Middle Name:LEE
Last Name:BIRD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 HILLSIDE AVE
Mailing Address - Street 2:
Mailing Address - City:SARATOGA SPRINGS
Mailing Address - State:NY
Mailing Address - Zip Code:12866-5513
Mailing Address - Country:US
Mailing Address - Phone:518-584-0698
Mailing Address - Fax:
Practice Address - Street 1:30 HILLSIDE AVE
Practice Address - Street 2:
Practice Address - City:SARATOGA SPRINGS
Practice Address - State:NY
Practice Address - Zip Code:12866-5513
Practice Address - Country:US
Practice Address - Phone:518-584-0698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0735661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYCC9643Medicare ID - Type UnspecifiedPROVIDER NUMBER