Michael Bodrero, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

10513315-3502 Issued in UT

Practice address

15 S Main St # B101
Providence, UT 84332-9786

Phone

(435) 512-2275

NPI assigned

Sep 9, 2019

Last updated

Jul 31, 2023By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1567987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1690761600000",
    "number": "1245889682",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST # B101",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329786",
            "telephone_number": "435-512-2275"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15 S MAIN ST # B101",
            "city": "PROVIDENCE",
            "state": "UT",
            "postal_code": "843329786",
            "telephone_number": "435-512-2275"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1683 S Hwy 89",
            "address_purpose": "LOCATION",
            "city": "Logan",
            "state": "UT",
            "postal_code": "843216212",
            "country_code": "US",
            "telephone_number": "435-512-2275",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BODRERO",
        "first_name": "MICHAEL",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2019-09-09",
        "last_updated": "2023-07-31",
        "certification_date": "2023-07-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "UT",
            "license": "10513315-3502",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DOPL",
            "identifier": "10513315-3502",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Troy Benallie
• Lars Bergeson, M.D.
• Lyndsey Bergsjo, RBT
• Jaylee Berry
• Clara Blake, RBT
• Kerri Lee Bordelon, MSW, CSW
• Allen Joshua Boyd, RBT
• Ben P Boyer, FNP
• Cheyanne J Bradshaw, RBT
• Cliffton K Brady, DC

• Clinical Social Worker in Providence, UT
• Providers in Providence, UT by specialty
• Clinical Social Worker in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.