Provider Demographics
NPI:1336694660
Name:GODINEZ, MICHELLE AMBER (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:MICHELLE
Middle Name:AMBER
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 DOUGLAS DR STE 140
Mailing Address - Street 2:
Mailing Address - City:MARTINEZ
Mailing Address - State:CA
Mailing Address - Zip Code:94553-4078
Mailing Address - Country:US
Mailing Address - Phone:925-412-0494
Mailing Address - Fax:
Practice Address - Street 1:10 DOUGLAS DR STE 140
Practice Address - Street 2:
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4078
Practice Address - Country:US
Practice Address - Phone:925-412-0494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1022831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical