Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 37PC00753400 | NJ |
NPI | 1003494428 |
---|---|
Provider Name | Colleen Bodek |
First Address | Cranford, NJ 07016-5531 |
Second Address | Mount Laurel, NJ 08054-3428 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/03/2021 |
Last Update Date | 29/03/2021 |