| Jeannine Bodner, Lcsw, Pllc | |
|
120-d South Village Lane Davidson NC 28036-8877 | |
| (704) 995-7686 | |
| (704) 659-4010 |
| Full Name | Jeannine Bodner, Lcsw, Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 120-d South Village Lane, Davidson, North Carolina |
| Authorized Official Name and Position | Jeannine Bodner (OWNER) |
| Authorized Official Contact | 7049957686 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Jeannine Bodner, Lcsw, Pllc 120-d South Village Lane Davidson NC 28036-8877 Ph: (704) 995-7686 | Jeannine Bodner, Lcsw, Pllc 120-d South Village Lane Davidson NC 28036-8877 Ph: (704) 995-7686 |
| NPI Number | 1255792156 |
|---|---|
| Provider Enumeration Date | 03/19/2016 |
| Last Update Date | 10/03/2018 |
| Medicare PECOS PAC ID | 5799083275 |
|---|---|
| Medicare Enrollment ID | O20160418000308 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1255792156 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | C009794 (North Carolina) | Primary |
| Provider Name | Jeannine M Bodner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1932443181 PECOS PAC ID: 0446551543 Enrollment ID: I20151215000685 |
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