Provider Demographics
NPI:1841934569
Name:DODARD, MYRIAM
Entity type:Individual
Prefix:
First Name:MYRIAM
Middle Name:
Last Name:DODARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MYRIAM
Other - Middle Name:
Other - Last Name:DODARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PMHNP, BC
Mailing Address - Street 1:PO BOX 563
Mailing Address - Street 2:
Mailing Address - City:FALLSTON
Mailing Address - State:MD
Mailing Address - Zip Code:21047-0563
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2503 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:FALLSTON
Practice Address - State:MD
Practice Address - Zip Code:21047-2101
Practice Address - Country:US
Practice Address - Phone:410-652-5068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-27
Last Update Date:2022-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2022004482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health