Kaylee A Bodner, LCSW-A, LCAS-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

P017755 Issued in NC

Practice address

120 S Village LN Ste D
Davidson, NC 28036-8159

Phone

(704) 255-5155

NPI assigned

Oct 10, 2022

Last updated

Oct 10, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Jeannine Bodner LCSW PLLCGroup PAC ID 5799083275, 2 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Jeannine Bodner, LCSW, PLLC

  • Clinical Social Worker
  • Davidson, NC
  • NPI 1255792156
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1665360000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1665360000000",
    "number": "1699490938",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2705 HAVERFORD PL APT 416",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282091415",
            "telephone_number": "704-999-0670"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "120 S VILLAGE LN STE D",
            "city": "DAVIDSON",
            "state": "NC",
            "postal_code": "280368159",
            "telephone_number": "704-255-5155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODNER",
        "first_name": "KAYLEE",
        "middle_name": "A",
        "credential": "LCSW-A, LCAS-A",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-10-10",
        "last_updated": "2022-10-10",
        "certification_date": "2022-10-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "NC",
            "license": "LCAS-28128",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "P017755",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Blossom Families Inc
• Blossom Families Inc
• Bob Anderson, PH.D., PC (Solutions by the Lake)
• Zofia Bochacki, MD
• Jeannine Bodner, LCSW
• Samantha Boone, RN
• Amanda Jones Bossert, CRC, LCMHCA
• Lynneice Lasinda Bowen, MD
• BPM Counseling, PLLC
• Brandi R. Jackson DDS, Ms, PLLC (Northeast Pediatric Dentistry)

• Clinical Social Worker in Davidson, NC
• Providers in Davidson, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.