Provider Demographics
NPI:1003842311
Name:BODDIE, WILLIAM LEON II (LCSW)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:LEON
Last Name:BODDIE
Suffix:II
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1524 MCHENRY AVE
Mailing Address - Street 2:SUITE # 450
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95350-4500
Mailing Address - Country:US
Mailing Address - Phone:209-557-6217
Mailing Address - Fax:209-557-9032
Practice Address - Street 1:1524 MCHENRY AVE
Practice Address - Street 2:SUITE # 450
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95350-4500
Practice Address - Country:US
Practice Address - Phone:209-557-6217
Practice Address - Fax:209-557-9032
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALSW # 212941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05000PWI LCS21294016OtherBLUE SHIELD OF CALIFORNIA
CA193184OtherKAISER