Provider Demographics
NPI:1801343959
Name:BODANZA, MATTHEW ROSARIO
Entity type:Individual
Prefix:MR
First Name:MATTHEW
Middle Name:ROSARIO
Last Name:BODANZA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 SCHOOL ST
Mailing Address - Street 2:
Mailing Address - City:LEOMINSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01453-3324
Mailing Address - Country:US
Mailing Address - Phone:978-410-9184
Mailing Address - Fax:
Practice Address - Street 1:36 SCHOOL ST
Practice Address - Street 2:
Practice Address - City:LEOMINSTER
Practice Address - State:MA
Practice Address - Zip Code:01453-3324
Practice Address - Country:US
Practice Address - Phone:978-410-9184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health