Provider Demographics
NPI:1821374737
Name:GODIWALA, STEPHANIE TAYLOR (LCMFT)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:TAYLOR
Last Name:GODIWALA
Suffix:
Gender:F
Credentials:LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 OLIVER HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-5067
Mailing Address - Country:US
Mailing Address - Phone:252-531-6828
Mailing Address - Fax:443-394-2639
Practice Address - Street 1:116 OLIVER HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5067
Practice Address - Country:US
Practice Address - Phone:252-531-6828
Practice Address - Fax:443-394-2639
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-25
Last Update Date:2011-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY23828101YA0400X
MDLCM434106H00000X
NY06 000749106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)