Provider Demographics
NPI:1104005214
Name:BODENMILLER, JOSEPH JEFFERY (LCSW)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:JEFFERY
Last Name:BODENMILLER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1202 CAMP ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70130-4204
Mailing Address - Country:US
Mailing Address - Phone:504-616-7119
Mailing Address - Fax:504-598-2771
Practice Address - Street 1:1202 CAMP ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70130-4204
Practice Address - Country:US
Practice Address - Phone:504-616-7119
Practice Address - Fax:504-598-2771
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-25
Last Update Date:2007-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA24231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical