Provider Demographics
NPI:1124259023
Name:BORDA, CHARMAINE S (PHD, LMHC, MFT)
Entity type:Individual
Prefix:DR
First Name:CHARMAINE
Middle Name:S
Last Name:BORDA
Suffix:
Gender:F
Credentials:PHD, LMHC, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 17123
Mailing Address - Street 2:
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33318-7123
Mailing Address - Country:US
Mailing Address - Phone:954-701-0241
Mailing Address - Fax:
Practice Address - Street 1:1860 N PINE ISLAND RD
Practice Address - Street 2:SUITE 101
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33322-5239
Practice Address - Country:US
Practice Address - Phone:954-701-0241
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-27
Last Update Date:2009-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 7781101YM0800X
FLIMT352106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist