Provider Demographics
NPI:1629234455
Name:BOODY, JOANNA MAE (MA, PSYCH)
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:MAE
Last Name:BOODY
Suffix:
Gender:F
Credentials:MA, PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1646 W HOUSATONIC ST
Mailing Address - Street 2:
Mailing Address - City:PITTSFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01201-7520
Mailing Address - Country:US
Mailing Address - Phone:413-281-9597
Mailing Address - Fax:
Practice Address - Street 1:1646 W HOUSATONIC ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-7520
Practice Address - Country:US
Practice Address - Phone:413-281-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2008-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist