Provider Demographics
NPI:1790076396
Name:GODSOE, MARIN RATHBUN
Entity Type:Individual
Prefix:DR
First Name:MARIN
Middle Name:RATHBUN
Last Name:GODSOE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 BIG SKY LN
Mailing Address - Street 2:
Mailing Address - City:WATERVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04901-4340
Mailing Address - Country:US
Mailing Address - Phone:603-762-3392
Mailing Address - Fax:
Practice Address - Street 1:2 BIG SKY LN
Practice Address - Street 2:
Practice Address - City:WATERVILLE
Practice Address - State:ME
Practice Address - Zip Code:04901-4340
Practice Address - Country:US
Practice Address - Phone:207-872-5800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-29
Last Update Date:2011-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS1313103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical