Individual
JAMIE BODENLOS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
73 CHERRY TREE CIR, LIVERPOOL, NY 13090-2451
(508) 414-6621
Mailing address
73 CHERRY TREE CIR, LIVERPOOL, NY 13090-2451
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
019183
NY
Other
Enumeration date
01/09/2014
Last updated
01/09/2014
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