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General NPI Number Information
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NPI Number | 1548422652
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Entity Type | Organization
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Legal Business Name | HOLLI L BODNER PSY D P A
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 51 WALLACE AVE
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City | SARASOTA
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State | FL
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Zip | 34237-6025
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Country | US
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Telephone | 941-351-8333
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Fax | 941-359-3148
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Provider Business Mailing Address
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Address Line | 51 WALLACE AVE
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City | SARASOTA
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State | FL
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Zip | 34237-6025
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Country | US
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Telephone | 941-351-8333
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Fax | 941-359-3148
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Authorized Official
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Title or Position | OWNER
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Name | HOLLI L BODNER
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Credential | PSY D
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Telephone | 941-351-8333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PY0004288
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License Number State | FL
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