Healthcare Provider Details

I. General information

NPI: 1639595218
Provider Name (Legal Business Name): SARAH BODNAR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2014
Last Update Date: 04/18/2020
Certification Date: 04/18/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

631 CEDAR AVE
SCRANTON PA
18505-1211
US

IV. Provider business mailing address

631 CEDAR AVE
SCRANTON PA
18505-1211
US

V. Phone/Fax

Practice location:
  • Phone: 570-346-6203
  • Fax: 570-346-3060
Mailing address:
  • Phone: 570-346-6203
  • Fax: 570-346-3060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW129907
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW019795
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: