Provider Demographics
NPI:1790241966
Name:GODFROY, ERIC ROBERT (LMSW, LCSW)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:ROBERT
Last Name:GODFROY
Suffix:
Gender:M
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 NE 81ST ST
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64118-1304
Mailing Address - Country:US
Mailing Address - Phone:816-206-4397
Mailing Address - Fax:
Practice Address - Street 1:1800 E TRUMAN RD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64127-1938
Practice Address - Country:US
Practice Address - Phone:816-404-1000
Practice Address - Fax:816-404-6318
Is Sole Proprietor?:No
Enumeration Date:2019-02-13
Last Update Date:2019-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS9646104100000X
MO20180168951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker