Healthcare Provider Details

I. General information

NPI: 1700706082
Provider Name (Legal Business Name): BONNIE BODEN LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 PIKE ST STE 2
LEMONT PA
16851-9085
US

IV. Provider business mailing address

PO BOX 1122
LEMONT PA
16851-1122
US

V. Phone/Fax

Practice location:
  • Phone: 814-965-7607
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW143723
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: