| Heather Bodie Therapy Llc | |
|
567 Vauxhall Street Ext Ste 102 Waterford CT 06385-4331 | |
| (203) 927-7364 | |
| Not Available |
| Full Name | Heather Bodie Therapy Llc |
|---|---|
| Speciality | Social Worker |
| Location | 567 Vauxhall Street Ext Ste 102, Waterford, Connecticut |
| Authorized Official Name and Position | Heather Bodie (PROVIDING OWNER) |
| Authorized Official Contact | 2039277364 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Heather Bodie Therapy Llc 11 Pevetty Dr East Haven CT 06512-4816 Ph: () - | Heather Bodie Therapy Llc 567 Vauxhall Street Ext Ste 102 Waterford CT 06385-4331 Ph: (203) 927-7364 |
| NPI Number | 1225790066 |
|---|---|
| Provider Enumeration Date | 10/08/2021 |
| Last Update Date | 10/31/2023 |
| Certification Date | 10/31/2023 |
| Medicare PECOS PAC ID | 9234527599 |
|---|---|
| Medicare Enrollment ID | O20211019003115 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1225790066 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Heather Nicole Bodie |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1477195899 PECOS PAC ID: 8224460498 Enrollment ID: I20191111000720 |
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