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General NPI Number Information
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NPI Number | 1285820811
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Entity Type | Individual
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Provider Name | LISA MARIE BODENHEIMER LSW
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Gender | Female
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Dates
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Enumeration Date | 09/18/2007
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 42 E LAUREL RD STE 1800-A
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City | STRATFORD
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State | NJ
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Zip | 08084-1354
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Country | US
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Telephone | 856-566-6843
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Fax | 856-566-2775
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Provider Business Mailing Address
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Address Line | 42 E LAUREL RD STE 1800-A
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City | STRATFORD
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State | NJ
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Zip | 08084-1354
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Country | US
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Telephone | 856-566-6843
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Fax | 856-566-2775
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | SW125822
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05679500
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License Number State | NJ
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