Provider Demographics
NPI:1477195899
Name:BODIE, HEATHER NICOLE (LCSW)
Entity Type:Individual
Prefix:
First Name:HEATHER
Middle Name:NICOLE
Last Name:BODIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 PEVETTY DR
Mailing Address - Street 2:
Mailing Address - City:EAST HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-4816
Mailing Address - Country:US
Mailing Address - Phone:203-927-7364
Mailing Address - Fax:
Practice Address - Street 1:163 BOSTON POST RD STE 2-2C
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-2840
Practice Address - Country:US
Practice Address - Phone:203-927-7364
Practice Address - Fax:888-492-8998
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-17
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0097871041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical