Provider Demographics
NPI:1316385420
Name:BODKIN, LAUREN LOUISE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:LOUISE
Last Name:BODKIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 PELHAM PKWY S
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10461-1116
Mailing Address - Country:US
Mailing Address - Phone:718-430-3900
Mailing Address - Fax:
Practice Address - Street 1:1410 PELHAM PKWY S
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1116
Practice Address - Country:US
Practice Address - Phone:718-430-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-11
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018532-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical