Provider Demographics
NPI:1033486873
Name:BODKIN, ROSELYNNE
Entity Type:Individual
Prefix:MS
First Name:ROSELYNNE
Middle Name:
Last Name:BODKIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-1812
Mailing Address - Country:US
Mailing Address - Phone:617-554-2275
Mailing Address - Fax:617-547-4356
Practice Address - Street 1:5 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-1812
Practice Address - Country:US
Practice Address - Phone:617-554-2275
Practice Address - Fax:617-547-4356
Is Sole Proprietor?:No
Enumeration Date:2011-11-22
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health