Provider Demographics
NPI:1811189509
Name:BODNAR, LESLY YANETH (PHD)
Entity Type:Individual
Prefix:DR
First Name:LESLY
Middle Name:YANETH
Last Name:BODNAR
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LESLIE
Other - Middle Name:YANETH
Other - Last Name:URIAS-BODNAR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:5 STORMS DR
Mailing Address - Street 2:
Mailing Address - City:MAHWAH
Mailing Address - State:NJ
Mailing Address - Zip Code:07430-3177
Mailing Address - Country:US
Mailing Address - Phone:201-803-1502
Mailing Address - Fax:
Practice Address - Street 1:1157 MAIN AVE
Practice Address - Street 2:
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07011-2243
Practice Address - Country:US
Practice Address - Phone:973-553-1433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2018-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJTP-183-067103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical