Provider Demographics
NPI:1598901688
Name:BRODY, BONNIE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:BONNIE
Middle Name:
Last Name:BRODY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BUTTONWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:CORTLANDT MANOR
Mailing Address - State:NY
Mailing Address - Zip Code:10567-4912
Mailing Address - Country:US
Mailing Address - Phone:914-736-0692
Mailing Address - Fax:
Practice Address - Street 1:206 BUTTONWOOD AVE
Practice Address - Street 2:
Practice Address - City:CORTLANDT MANOR
Practice Address - State:NY
Practice Address - Zip Code:10567-4912
Practice Address - Country:US
Practice Address - Phone:914-736-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-19
Last Update Date:2008-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0538381104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0538381OtherSOCIAL WORK LICENSE