Provider Demographics
NPI:1831236058
Name:BODKIN, KATHERINE ANN (LCSW)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:ANN
Last Name:BODKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 HARLOW ST
Mailing Address - Street 2:#222
Mailing Address - City:BANGOR
Mailing Address - State:ME
Mailing Address - Zip Code:04401-4954
Mailing Address - Country:US
Mailing Address - Phone:207-989-8955
Mailing Address - Fax:207-989-5759
Practice Address - Street 1:96 HARLOW ST
Practice Address - Street 2:#222
Practice Address - City:BANGOR
Practice Address - State:ME
Practice Address - Zip Code:04401-4954
Practice Address - Country:US
Practice Address - Phone:207-989-8955
Practice Address - Fax:207-989-5759
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC1681104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
7556188OtherAETNA
ME003813OtherANTHEM BCBS