Provider Demographics
NPI:1275801144
Name:GODEFROY, MARY ANN (LPC, LCADC)
Entity Type:Individual
Prefix:
First Name:MARY ANN
Middle Name:
Last Name:GODEFROY
Suffix:
Gender:F
Credentials:LPC, LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 CHESTNUT STREET
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08542
Mailing Address - Country:US
Mailing Address - Phone:609-937-2407
Mailing Address - Fax:
Practice Address - Street 1:17 CHESTNUT STREET
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542
Practice Address - Country:US
Practice Address - Phone:609-937-2407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2011-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00176100101YA0400X
NJ37PC00433300101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)