Provider Demographics
NPI:1477633238
Name:BODWELL, NANCY M (MSW LICSW)
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:M
Last Name:BODWELL
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 OAKLAND ST # 2
Mailing Address - Street 2:
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2127
Mailing Address - Country:US
Mailing Address - Phone:978-462-2022
Mailing Address - Fax:978-462-3900
Practice Address - Street 1:PO BOX 236
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-0236
Practice Address - Country:US
Practice Address - Phone:978-462-2022
Practice Address - Fax:978-462-3900
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10178661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP22302Medicare ID - Type Unspecified