Provider Demographics
NPI:1033661277
Name:GODOI, THIAGO (CNP)
Entity Type:Individual
Prefix:
First Name:THIAGO
Middle Name:
Last Name:GODOI
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:209 W CENTRAL ST STE 102
Mailing Address - Street 2:
Mailing Address - City:NATICK
Mailing Address - State:MA
Mailing Address - Zip Code:01760-3716
Mailing Address - Country:US
Mailing Address - Phone:774-507-0925
Mailing Address - Fax:508-250-0733
Practice Address - Street 1:209 W CENTRAL ST STE 102
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-3716
Practice Address - Country:US
Practice Address - Phone:774-507-0925
Practice Address - Fax:508-250-0733
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-03
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2283229163WP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty