Provider Demographics
NPI:1881713006
Name:BODNAR, ROBERT S (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:S
Last Name:BODNAR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 EXECUTIVE DR
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CRANBERRY TWP
Mailing Address - State:PA
Mailing Address - Zip Code:16066-6406
Mailing Address - Country:US
Mailing Address - Phone:724-776-5690
Mailing Address - Fax:724-776-5611
Practice Address - Street 1:215 EXECUTIVE DR
Practice Address - Street 2:SUITE 102
Practice Address - City:CRANBERRY TWP
Practice Address - State:PA
Practice Address - Zip Code:16066-6406
Practice Address - Country:US
Practice Address - Phone:724-776-5690
Practice Address - Fax:724-776-5611
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS-003621-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
570835OtherHIGHMARK
19-001834802OtherPROMISE
215834OtherUPMC
PA41-01834802Medicaid
058172 A041153OtherVBH-PA
61-00250OtherUNITED BEHAVIORAL HEALTH
PA058172 A796230OtherVBH-PA
2023505OtherCIGNA
4587159OtherAETNA