Provider Demographics
NPI:1629408828
Name:GODOY, AMNERIS (LCSW)
Entity Type:Individual
Prefix:
First Name:AMNERIS
Middle Name:
Last Name:GODOY
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 1:1207 MOCKINGBIRD RD
Mailing Address - Street 2:
Mailing Address - City:KEY LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33037-3887
Mailing Address - Country:US
Mailing Address - Phone:786-417-7300
Mailing Address - Fax:
Practice Address - Street 1:1207 MOCKINGBIRD RD
Practice Address - Street 2:
Practice Address - City:KEY LARGO
Practice Address - State:FL
Practice Address - Zip Code:33037-3887
Practice Address - Country:US
Practice Address - Phone:786-417-7300
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-25
Last Update Date:2018-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW-116911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020935200Medicaid