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General NPI Number Information
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NPI Number | 1477195899
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Entity Type | Individual
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Provider Name | HEATHER NICOLE BODIE LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/17/2019
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Last Update Date | 06/11/2025
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Provider Practice Location Address
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Address Line | 567 VAUXHALL STREET EXT STE 102
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City | WATERFORD
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State | CT
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Zip | 06385-4331
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Country | US
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Telephone | 203-927-7364
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Fax | 888-492-8998
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Provider Business Mailing Address
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Address Line | 14103 MAPLE TREE LN
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City | EAST LYME
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State | CT
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Zip | 06333-1755
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Country | US
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Telephone | 203-927-7364
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Fax |
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 009787
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License Number State | CT
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