Provider Demographics
NPI:1861845224
Name:GODDARD, ANDREA (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:GODDARD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1916 17TH ST NW
Mailing Address - Street 2:UNIT 210
Mailing Address - City:WASHINGTON, DC
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:US
Mailing Address - Phone:773-677-7960
Mailing Address - Fax:
Practice Address - Street 1:720 ALICEANNA STREET
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21202
Practice Address - Country:US
Practice Address - Phone:433-923-7533
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist