MEDICARE: BOODAH, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker
3	103T00000X	Psychologist
4	103G00000X	Clinical Neuropsychologist
5	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1104390525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BOODAH, INC

Provider Business Mailing Address
First Line	:	136 DWIGHT RD
Second Line	:
City	:	LONGMEADOW
State	:	MA
Zip	:	01106-2075
Country	:	US
Telephone Number	:	781-287-8676
Fax Number	:	800-593-2560

Provider Business Practice Location Address
First Line	:	32 COURT ST STE 7
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-8733
Country	:	US
Telephone Number	:	774-426-7707
Fax Number	:	800-593-2560

Authorized Official
Title or Position	:	VP OF FINANCE
Name	:	MS. AMY SOWA
Credential	:
Telephone Number	:	413-205-8617

Provider Enumeration Date	:	01/18/2019
Last Update Date	:	03/11/2026

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Directions to “BOODAH, INC ” Practice Location

Language	Start Address	Practice Location

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