Provider Demographics
NPI:1134744121
Name:BODDEN, ROSHALENE MARY
Entity type:Individual
Prefix:
First Name:ROSHALENE
Middle Name:MARY
Last Name:BODDEN
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 1:792 S MAIN ST STE 102A
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:02048-3137
Mailing Address - Country:US
Mailing Address - Phone:508-296-0233
Mailing Address - Fax:
Practice Address - Street 1:792 S MAIN ST STE 102A
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:MA
Practice Address - Zip Code:02048-3137
Practice Address - Country:US
Practice Address - Phone:508-296-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-06-15
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator