| Charles E. Dodgen, Ph.d., L.l.c. | |
|
526 Bloomfield Ave Caldwell NJ 07006-5564 | |
| (973) 514-1774 | |
| (973) 228-5530 |
| Full Name | Charles E. Dodgen, Ph.d., L.l.c. |
|---|---|
| Speciality | Psychologist |
| Location | 526 Bloomfield Ave, Caldwell, New Jersey |
| Authorized Official Name and Position | Charles E. Dodgen (PSYCHOLOGIST) |
| Authorized Official Contact | 9735141774 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Charles E. Dodgen, Ph.d., L.l.c. 526 Bloomfield Ave Caldwell NJ 07006-5564 Ph: (973) 514-1774 | Charles E. Dodgen, Ph.d., L.l.c. 526 Bloomfield Ave Caldwell NJ 07006-5564 Ph: (973) 514-1774 |
| NPI Number | 1184872541 |
|---|---|
| Provider Enumeration Date | 08/28/2008 |
| Last Update Date | 08/28/2008 |
| Medicare PECOS PAC ID | 6608938105 |
|---|---|
| Medicare Enrollment ID | O20081217000379 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1184872541 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103TC0700X | Psychologist - Clinical | (* (Not Available)) | Primary |
| Provider Name | Charles E Dodgen |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1558427633 PECOS PAC ID: 8729021530 Enrollment ID: I20050602000853 |
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