Provider Demographics
NPI:1609199058
Name:GODDER, GEFFEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GEFFEN
Middle Name:
Last Name:GODDER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:GEFFEN
Other - Middle Name:GODDER
Other - Last Name:ALTSCHULER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2499 GLADES RD
Mailing Address - Street 2:SUITE 108
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33431-7209
Mailing Address - Country:US
Mailing Address - Phone:561-900-4331
Mailing Address - Fax:
Practice Address - Street 1:2499 GLADES RD
Practice Address - Street 2:SUITE 108
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33431-7209
Practice Address - Country:US
Practice Address - Phone:561-900-4331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-11
Last Update Date:2012-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018448-1103T00000X
FLPY8360103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist