Provider Demographics
NPI:1184640013
Name:BODNER, HOLLI (PSY D)
Entity Type:Individual
Prefix:
First Name:HOLLI
Middle Name:
Last Name:BODNER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:51 WALLACE AVE
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34237-6025
Mailing Address - Country:US
Mailing Address - Phone:941-351-8333
Mailing Address - Fax:941-358-7229
Practice Address - Street 1:51 WALLACE AVE
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-6025
Practice Address - Country:US
Practice Address - Phone:941-351-8333
Practice Address - Fax:941-358-7229
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-14
Last Update Date:2008-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73707Medicare PIN