Provider Demographics
NPI:1922044635
Name:GODOY, ALEJANDRO ALFREDO (LCSW R)
Entity Type:Individual
Prefix:MR
First Name:ALEJANDRO
Middle Name:ALFREDO
Last Name:GODOY
Suffix:
Gender:M
Credentials:LCSW R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 HOLLY DRIVE
Mailing Address - Street 2:
Mailing Address - City:SAYVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:11782-1306
Mailing Address - Country:US
Mailing Address - Phone:631-567-6930
Mailing Address - Fax:
Practice Address - Street 1:20 MONTAUK HIGHWAY
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715
Practice Address - Country:US
Practice Address - Phone:631-244-0954
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR04671211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02246835Medicaid
NYNV4161Medicare ID - Type Unspecified