Provider Demographics
NPI:1356842736
Name:BRYNN BODI, LMSW, L.L.C.
Entity Type:Organization
Organization Name:BRYNN BODI, LMSW, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:BRYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:734-408-1442
Mailing Address - Street 1:452 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:GRASS LAKE
Mailing Address - State:MI
Mailing Address - Zip Code:49240-9501
Mailing Address - Country:US
Mailing Address - Phone:207-355-5929
Mailing Address - Fax:
Practice Address - Street 1:455 E EISENHOWER PKWY STE 15
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-3321
Practice Address - Country:US
Practice Address - Phone:734-408-1442
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-02-22
Last Update Date:2018-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty