Provider Demographics
NPI:1346396835
Name:BODEN, EVE R H (MSW LCSW)
Entity Type:Individual
Prefix:MRS
First Name:EVE
Middle Name:R H
Last Name:BODEN
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 SEXTON RD
Mailing Address - Street 2:
Mailing Address - City:SYOSSET
Mailing Address - State:NY
Mailing Address - Zip Code:11791-6610
Mailing Address - Country:US
Mailing Address - Phone:516-938-7770
Mailing Address - Fax:516-433-8967
Practice Address - Street 1:32 SEXTON RD
Practice Address - Street 2:
Practice Address - City:SYOSSET
Practice Address - State:NY
Practice Address - Zip Code:11791-6610
Practice Address - Country:US
Practice Address - Phone:516-938-7770
Practice Address - Fax:516-433-8967
Is Sole Proprietor?:No
Enumeration Date:2007-01-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0190051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN15711Medicare ID - Type Unspecified