Provider Demographics
NPI:1346123163
Name:BODRATO, JOVAN JORDAN
Entity type:Individual
Prefix:
First Name:JOVAN
Middle Name:JORDAN
Last Name:BODRATO
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 33RD ST STE 100
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32839-8858
Mailing Address - Country:US
Mailing Address - Phone:407-553-6336
Mailing Address - Fax:
Practice Address - Street 1:1724 33RD ST STE 100
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32839-8858
Practice Address - Country:US
Practice Address - Phone:407-553-6336
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-29
Last Update Date:2025-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH27768101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health