Heather Jordan Boddie-Russo, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

LCS 29058 Issued in CA

Practice address

2101 Alexian Dr
Suite D
San Jose, CA 95116-1901

Phone

(408) 272-6513

Fax

(408) 272-6557

NPI assigned

Sep 25, 2013

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Peninsula Healthcare Connection, Inc.

  • Case Management Agency
  • Palo Alto, CA
  • NPI 1033516828
  NPD

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

{
    "created_epoch": "1380067200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532908800000",
    "number": "1588090286",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1671 THE ALAMEDA",
            "address_2": "STE 306",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951262222",
            "telephone_number": "408-472-1103",
            "fax_number": "408-320-4252"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2101 ALEXIAN DR",
            "address_2": "SUITE D",
            "city": "SAN JOSE",
            "state": "CA",
            "postal_code": "951161901",
            "telephone_number": "408-272-6513",
            "fax_number": "408-272-6557"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODDIE-RUSSO",
        "first_name": "HEATHER",
        "middle_name": "JORDAN",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-09-25",
        "last_updated": "2018-07-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "LCS 29058",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christine Bobb, M.A. CCC-SLP
• Vidya Bobba, D.M.D.
• Rayshonte' Jovonna Bocage
• Charles Rudolph Bocks III, DDS
• Fitsum Bocru
• Priyanka Boddu
• Devi Prathyusha Bodduri
• David William Bodine
• Shannon Nicole Boe
• Carolin Anne Boecking, M.D.

• Clinical Social Worker in San Jose, CA
• Providers in San Jose, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 30, 2018; 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.