Provider Demographics
NPI:1619040334
Name:GODFREY, KIMBERLY A (MS)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:A
Last Name:GODFREY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 GRANBY ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-2810
Mailing Address - Country:US
Mailing Address - Phone:413-539-2816
Mailing Address - Fax:
Practice Address - Street 1:1123 MAIN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01103-2116
Practice Address - Country:US
Practice Address - Phone:413-539-2816
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-17
Last Update Date:2010-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health