Provider Demographics
NPI:1851039101
Name:BODKIN, GABRIELLE NICOLE (LMHC)
Entity Type:Individual
Prefix:MRS
First Name:GABRIELLE
Middle Name:NICOLE
Last Name:BODKIN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7041 N SERENOA DR APT 269
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34241-9268
Mailing Address - Country:US
Mailing Address - Phone:941-915-0869
Mailing Address - Fax:
Practice Address - Street 1:7041 N SERENOA DR APT 269
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34241-9268
Practice Address - Country:US
Practice Address - Phone:941-915-0869
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-26
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20645101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty