Individual
MICHAEL BODRERO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LCSW
Contact information
Practice address
15 S MAIN ST # B101, PROVIDENCE, UT 84332-9786
(435) 512-2275
Mailing address
15 S MAIN ST # B101, PROVIDENCE, UT 84332-9786
(435) 512-2275
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
10513315-3502
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10513315-3502
DOPL
UT
Enumeration date
09/09/2019
Last updated
07/31/2023
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