Provider Demographics
NPI:1114586872
Name:GODOY, CAROLINA MANUELA
Entity Type:Individual
Prefix:
First Name:CAROLINA
Middle Name:MANUELA
Last Name:GODOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8070 NW 10TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33126-2843
Mailing Address - Country:US
Mailing Address - Phone:786-338-1651
Mailing Address - Fax:
Practice Address - Street 1:8070 NW 10TH ST APT 2
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33126-2843
Practice Address - Country:US
Practice Address - Phone:786-338-1651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-06
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician