Provider Demographics
NPI:1386284065
Name:ROHLFING DODSON, CYNTHIA SUSAN (LCSW)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUSAN
Last Name:ROHLFING DODSON
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 1:1100 TERRACE DR
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1335
Mailing Address - Country:US
Mailing Address - Phone:314-440-5783
Mailing Address - Fax:314-781-7914
Practice Address - Street 1:2814 SUTTON BLVD
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MO
Practice Address - Zip Code:63143-3010
Practice Address - Country:US
Practice Address - Phone:314-440-5783
Practice Address - Fax:314-781-7914
Is Sole Proprietor?:No
Enumeration Date:2020-01-10
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO004009101Y00000X, 101YP2500X, 104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1427226612OtherOPTUM
MO1427226612Medicaid