MEDICARE: ALEENA BODOE DMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist

General Provider Information

NPI Number	:	1558015156
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALEENA BODOE DMFT

Provider Business Mailing Address
First Line	:	43 KNIGHT BOXX RD STE 100
Second Line	:
City	:	ORANGE PARK
State	:	FL
Zip	:	32065-7395
Country	:	US
Telephone Number	:	904-379-8675
Fax Number	:

Provider Business Practice Location Address
First Line	:	8465 MERCHANTS WAY STE 104
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32222-2858
Country	:	US
Telephone Number	:	904-379-8675
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/11/2022
Last Update Date	:	02/11/2022

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Directions to “ ALEENA BODOE DMFT” Practice Location

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