Provider Demographics
NPI:1679941256
Name:GODOT, DAVID (PSYD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:
Last Name:GODOT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3950 LONG BEACH BLVD
Mailing Address - Street 2:STE 101
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-5410
Mailing Address - Country:US
Mailing Address - Phone:562-684-1305
Mailing Address - Fax:562-684-1301
Practice Address - Street 1:3950 LONG BEACH BLVD
Practice Address - Street 2:STE 101
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-5410
Practice Address - Country:US
Practice Address - Phone:562-684-1300
Practice Address - Fax:562-684-1301
Is Sole Proprietor?:No
Enumeration Date:2015-09-12
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY27572103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical