Individual provider Active NPI

Patricia Malvoisin Boddie, M.S., LMHC

  • Mental Health Counselor
  • Port St Lucie, FL
National Provider Identifier
1780076604
Registry record updated Nov 18, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
MH14448 Issued in FL
Practice address
2281 SW Gray Beal Ave
Port St Lucie, FL 34953-2769
Phone
(561) 452-0026
NPI assigned
Mar 2, 2015
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 18, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X MH14448 FL Primary

Addresses

Primary practice location

2281 SW Gray Beal Ave
Port St Lucie, FL 34953-2769

Mailing address

2281 SW Gray Beal Ave
Port St Lucie, FL 34953-2769
Phone (561) 452-0026

Other names 1

  • Mrs. Patricia Malvoisin-Boddie Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20240328000074 FL Practitioner - Mental Health Counselor 0042657850 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Mental Health Counselor
Education
Other, 2013
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
Grow Healthcare Group PAGroup PAC ID 3476961368, 1,045 clinicians

Practice addresses (Care Compare)

66 E Flagler St
Miami, FL 33130-1807
Phone (786) 244-7711

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
MH14448FLMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Grow Healthcare Group PA Mental Health CurrentSince Feb 22, 2024 Accepting new patients

Locations

66 W Flagler St
Ste 900
Miami, FL 33130
Phone (786) 244-7711

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1425254400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1668729600000",
    "number": "1780076604",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2281 SW GRAY BEAL AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349532769",
            "telephone_number": "561-452-0026"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2281 SW GRAY BEAL AVE",
            "city": "PORT ST LUCIE",
            "state": "FL",
            "postal_code": "349532769",
            "telephone_number": "561-452-0026"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BODDIE",
        "first_name": "PATRICIA",
        "middle_name": "MALVOISIN",
        "name_prefix": "Mrs.",
        "credential": "M.S., LMHC",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-03-02",
        "last_updated": "2022-11-18",
        "certification_date": "2022-11-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "MH14448",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "PATRICIA",
            "last_name": "MALVOISIN-BODDIE",
            "prefix": "MRS.",
            "credential": "M.S., LMHC",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Port St Lucie, FL

Sources for this page

Verify at the official NPI Registry.