Provider Demographics
NPI:1275730590
Name:GODFREY, SANDRA M (MSW, LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SANDRA
Middle Name:M
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 HOME ST
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11580-2836
Mailing Address - Country:US
Mailing Address - Phone:516-825-5830
Mailing Address - Fax:516-792-6881
Practice Address - Street 1:225 HOME ST
Practice Address - Street 2:
Practice Address - City:VALLEY STREAM
Practice Address - State:NY
Practice Address - Zip Code:11580-2836
Practice Address - Country:US
Practice Address - Phone:516-825-5830
Practice Address - Fax:516-792-6881
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049408-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical