Provider Demographics
NPI:1801487764
Name:BOOZER-MADISON, BERNADETTE LATRICIA (PHD, MSW, LMFT)
Entity type:Individual
Prefix:DR
First Name:BERNADETTE
Middle Name:LATRICIA
Last Name:BOOZER-MADISON
Suffix:
Gender:F
Credentials:PHD, MSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5557 BALTIMORE AVE STE 5002040
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1922
Mailing Address - Country:US
Mailing Address - Phone:202-810-3439
Mailing Address - Fax:301-560-1412
Practice Address - Street 1:5557 BALTIMORE AVE STE 5002040
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1922
Practice Address - Country:US
Practice Address - Phone:202-810-3439
Practice Address - Fax:301-560-1412
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLMFT000034106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist