Provider Demographics
NPI:1033400775
Name:GODFREY, ROBERT ALFRED III (MSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:ALFRED
Last Name:GODFREY
Suffix:III
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:802 STEWART AVE
Mailing Address - Street 2:
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-3663
Mailing Address - Country:US
Mailing Address - Phone:301-722-5066
Mailing Address - Fax:
Practice Address - Street 1:802 STEWART AVE
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-3663
Practice Address - Country:US
Practice Address - Phone:301-722-5066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-28
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD081321041C0700X
MD06521041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool