Provider Demographics
NPI:1639749872
Name:GODBOUT, NANCY CHARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:CHARLENE
Last Name:GODBOUT
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 1:670 AMHERST RD
Mailing Address - Street 2:
Mailing Address - City:GRANBY
Mailing Address - State:MA
Mailing Address - Zip Code:01033-9784
Mailing Address - Country:US
Mailing Address - Phone:413-255-0687
Mailing Address - Fax:413-255-0689
Practice Address - Street 1:670 AMHERST RD
Practice Address - Street 2:
Practice Address - City:GRANBY
Practice Address - State:MA
Practice Address - Zip Code:01033-9784
Practice Address - Country:US
Practice Address - Phone:413-255-0687
Practice Address - Fax:413-255-0689
Is Sole Proprietor?:No
Enumeration Date:2021-06-29
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1257611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical