=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962682898
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DONNA BODONY MSW, LICSW, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/08/2007
-----------------------------------------------------
Last Update Date | 11/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2 JOHN WILSON LN
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02421-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-258-7311
-----------------------------------------------------
Fax | 781-861-7773
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2 JOHN WILSON LN
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02421-6033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 781-258-7311
-----------------------------------------------------
Fax | 781-861-7773
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. DONNA LEE BODONY
-----------------------------------------------------
Credential | LICSW
-----------------------------------------------------
Telephone | 781-258-7311
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 1024434
-----------------------------------------------------
License Number State | MA
-----------------------------------------------------