Provider Demographics
NPI:1750422416
Name:BODONY, DONNA (LICSW)
Entity type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:
Last Name:BODONY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:
Other - Last Name:CACAMIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:2 JOHN WILSON LN
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6033
Mailing Address - Country:US
Mailing Address - Phone:781-861-1196
Mailing Address - Fax:
Practice Address - Street 1:9 MERIAM ST STE 26
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-5312
Practice Address - Country:US
Practice Address - Phone:781-258-7311
Practice Address - Fax:781-861-7773
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10244341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA339321OtherTRICARE
MAP10320OtherBCBS
MAP23471Medicare ID - Type Unspecified