Provider Demographics
NPI:1023479292
Name:BODNAR, KELLY ANNE
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANNE
Last Name:BODNAR
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 1:877 SOUTH ST
Mailing Address - Street 2:SUITE NUMBER 300
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-8242
Mailing Address - Country:US
Mailing Address - Phone:413-236-5656
Mailing Address - Fax:
Practice Address - Street 1:877 SOUTH ST
Practice Address - Street 2:SUITE NUMBER 300
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-8242
Practice Address - Country:US
Practice Address - Phone:413-236-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-15
Last Update Date:2016-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor