Provider Demographics
NPI:1992122865
Name:BODZIOCH, MARY JOY (PHD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:JOY
Last Name:BODZIOCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:JOY
Other - Last Name:BROCKMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3263 VINEYARD AVE
Mailing Address - Street 2:SPC 175
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94566-6384
Mailing Address - Country:US
Mailing Address - Phone:925-400-5744
Mailing Address - Fax:
Practice Address - Street 1:231 OLD BERNAL AVE
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94566-7015
Practice Address - Country:US
Practice Address - Phone:925-400-5744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2014-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25597103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist