Provider Demographics
NPI:1043601693
Name:GODINGER, TINA (LCSW)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:GODINGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 E 14TH ST
Mailing Address - Street 2:APT 2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10009-2927
Mailing Address - Country:US
Mailing Address - Phone:917-974-4203
Mailing Address - Fax:
Practice Address - Street 1:41 E 11TH ST # 51
Practice Address - Street 2:4TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003-4602
Practice Address - Country:US
Practice Address - Phone:917-974-4203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-17
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY063199106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist