Provider Demographics
NPI:1578172961
Name:BODO, EMILY ELAINE
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:ELAINE
Last Name:BODO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2915 SIDNEY ST APT 415
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-3305
Mailing Address - Country:US
Mailing Address - Phone:740-424-3750
Mailing Address - Fax:
Practice Address - Street 1:2915 SIDNEY ST APT 415
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15203-3305
Practice Address - Country:US
Practice Address - Phone:740-424-3750
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-30
Last Update Date:2020-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health