Provider Demographics
NPI:1235736141
Name:BODARY, BRIANNA R (LLMSW)
Entity Type:Individual
Prefix:
First Name:BRIANNA
Middle Name:R
Last Name:BODARY
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 586
Mailing Address - Street 2:
Mailing Address - City:ALPENA
Mailing Address - State:MI
Mailing Address - Zip Code:49707-0586
Mailing Address - Country:US
Mailing Address - Phone:989-340-1466
Mailing Address - Fax:989-538-8790
Practice Address - Street 1:311 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:ALPENA
Practice Address - State:MI
Practice Address - Zip Code:49707-2865
Practice Address - Country:US
Practice Address - Phone:989-340-1466
Practice Address - Fax:989-538-8790
Is Sole Proprietor?:No
Enumeration Date:2020-10-04
Last Update Date:2020-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI6801108196OtherLIMITED LICENSED MASTER SOCIAL WORK