Provider Demographics
NPI:1780076604
Name:BODDIE, PATRICIA MALVOISIN (MS, LMHC)
Entity type:Individual
Prefix:MRS
First Name:PATRICIA
Middle Name:MALVOISIN
Last Name:BODDIE
Suffix:
Gender:F
Credentials:MS, LMHC
Other - Prefix:MRS
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:MALVOISIN-BODDIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LMHC
Mailing Address - Street 1:2281 SW GRAY BEAL AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34953-2769
Mailing Address - Country:US
Mailing Address - Phone:561-452-0026
Mailing Address - Fax:
Practice Address - Street 1:2281 SW GRAY BEAL AVE
Practice Address - Street 2:
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34953-2769
Practice Address - Country:US
Practice Address - Phone:561-452-0026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-02
Last Update Date:2022-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14448101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health