Provider Demographics
NPI:1457840415
Name:GODOFSKY, MAYA (LICSW)
Entity Type:Individual
Prefix:
First Name:MAYA
Middle Name:
Last Name:GODOFSKY
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3611 SHEPHERD ST
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-4131
Mailing Address - Country:US
Mailing Address - Phone:917-691-5860
Mailing Address - Fax:
Practice Address - Street 1:4000 ALBEMARLE ST NW STE 200A
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20016-1859
Practice Address - Country:US
Practice Address - Phone:917-691-5860
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500782751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical