Healthcare Provider Details

I. General information

NPI: 1750737409
Provider Name (Legal Business Name): BONNIE HODES ACSW, PSYCHOANALYST
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2016
Last Update Date: 05/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 E 68TH ST SUITE 205
NEW YORK NY
10065-5844
US

IV. Provider business mailing address

565 PARK AVE
NEW YORK NY
10065-7344
US

V. Phone/Fax

Practice location:
  • Phone: 212-772-9055
  • Fax:
Mailing address:
  • Phone: 212-355-1912
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code102L00000X
TaxonomyPsychoanalyst
License Number025850
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: