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NPI Code Detail

MEDICARE: MRS. CRESTRE MERITA BODDY LCSW

MEDICARE:  MRS. CRESTRE MERITA BODDY  LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCSW005782GA

General Provider Information

NPI Number : 1598113276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. CRESTRE MERITA BODDY LCSW
Provider Business Mailing Address
First Line : 3330 CUMBERLAND BLVD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5997
Country : US
Telephone Number : 770-933-6222
Fax Number : 404-228-6597
Provider Business Practice Location Address
First Line : 3330 CUMBERLAND BLVD SE STE 500
Second Line :
City : ATLANTA
State : GA
Zip : 30339-5997
Country : US
Telephone Number : 770-933-6222
Fax Number : 404-228-6597
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/02/2016
Last Update Date : 06/02/2016

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Directions to “ MRS. CRESTRE MERITA BODDY LCSW” Practice Location

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