Provider Demographics
NPI:1235219627
Name:BODNAR, ALAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:
Last Name:BODNAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:288 LYMAN ST.
Mailing Address - Street 2:WESTBOROUGH STATE HOSPITAL
Mailing Address - City:WESTBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01581
Mailing Address - Country:US
Mailing Address - Phone:508-616-2548
Mailing Address - Fax:
Practice Address - Street 1:288 LYMAN ST.
Practice Address - Street 2:WESTBOROUGH STATE HOSPITAL
Practice Address - City:WESTBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01581
Practice Address - Country:US
Practice Address - Phone:508-616-2548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1767103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW02173Medicare ID - Type Unspecified