MEDICARE: MRS. BONNIE HODES ACSW, PSYCHOANALYST

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	102L00000X	Psychoanalyst	025850	NY

General Provider Information

NPI Number	:	1750737409
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BONNIE HODES ACSW, PSYCHOANALYST

Provider Business Mailing Address
First Line	:	565 PARK AVE
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10065-7344
Country	:	US
Telephone Number	:	212-355-1912
Fax Number	:

Provider Business Practice Location Address
First Line	:	20 E 68TH ST
Second Line	:	SUITE 205
City	:	NEW YORK
State	:	NY
Zip	:	10065-5844
Country	:	US
Telephone Number	:	212-772-9055
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/12/2016
Last Update Date	:	05/12/2016

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