Provider Demographics
NPI:1952673774
Name:BODNAR, CYNTHIA (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BODNAR
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5632 MOUNT VERNON MEMORIAL HWY
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22309-1502
Mailing Address - Country:US
Mailing Address - Phone:571-220-6930
Mailing Address - Fax:703-890-1610
Practice Address - Street 1:5632 MOUNT VERNON MEMORIAL HWY
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22309-1502
Practice Address - Country:US
Practice Address - Phone:571-220-6930
Practice Address - Fax:703-890-1610
Is Sole Proprietor?:No
Enumeration Date:2012-02-09
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-11-9566103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst