Provider Demographics
NPI:1164597043
Name:GODMAN, CAROLYN ELIZABETH (PHD, CCHP-MH)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:ELIZABETH
Last Name:GODMAN
Suffix:
Gender:F
Credentials:PHD, CCHP-MH
Other - Prefix:
Other - First Name:CAROLYN
Other - Middle Name:ELIZABETH
Other - Last Name:DAVIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:4231 BALBOA AVE #1256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117
Mailing Address - Country:US
Mailing Address - Phone:917-873-0759
Mailing Address - Fax:
Practice Address - Street 1:1048 BENITO AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950
Practice Address - Country:US
Practice Address - Phone:917-873-0759
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-23
Last Update Date:2022-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019200103T00000X
CAPSY28831103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist