| |
1523 Leighton Ave Anniston AL 36207-3828 | |
(256) 236-0070 | |
(256) 237-0079 |
Full Name | |
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Speciality | Psychologist |
Location | 1523 Leighton Ave, Anniston, Alabama |
Authorized Official Name and Position | Lucile Bodenheimer (LICENSED CLINICAL PSYCHOLGIST OWNER) |
Authorized Official Contact | 2562360070 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Po Box 952 Anniston AL 36202-0952 Ph: (256) 236-0070 | 1523 Leighton Ave Anniston AL 36207-3828 Ph: (256) 236-0070 |
NPI Number | 1972575272 |
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Provider Enumeration Date | 02/02/2006 |
Last Update Date | 08/29/2007 |
Medicare PECOS PAC ID | 3971498932 |
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Medicare Enrollment ID | O20040218000590 |
Identifier | Type | State | Issuer |
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1972575272 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
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103TC0700X | Psychologist - Clinical | 978 (Alabama) | Primary |
Provider Name | Lucile Bodenheimer |
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Provider Type | Practitioner - Clinical Psychologist |
Provider Identifiers | NPI Number: 1144405531 PECOS PAC ID: 9032001151 Enrollment ID: I20040325000717 |
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