Provider Demographics
NPI:1184861189
Name:GODDARD, STEPHANIE JANINE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:STEPHANIE
Middle Name:JANINE
Last Name:GODDARD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8967 YELLOW BRICK RD
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:MD
Mailing Address - Zip Code:21237-2303
Mailing Address - Country:US
Mailing Address - Phone:410-780-5203
Mailing Address - Fax:410-780-5203
Practice Address - Street 1:8967 YELLOW BRICK RD
Practice Address - Street 2:
Practice Address - City:ROSEDALE
Practice Address - State:MD
Practice Address - Zip Code:21237
Practice Address - Country:US
Practice Address - Phone:410-780-5203
Practice Address - Fax:410-780-5203
Is Sole Proprietor?:No
Enumeration Date:2009-01-13
Last Update Date:2019-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDG066941041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool