Provider Demographics
NPI:1942503131
Name:GODDARD, DENISE M (LMT)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:M
Last Name:GODDARD
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:275 MAIN ST REAR
Mailing Address - Street 2:
Mailing Address - City:WEBSTER
Mailing Address - State:MA
Mailing Address - Zip Code:01570-2262
Mailing Address - Country:US
Mailing Address - Phone:508-461-9796
Mailing Address - Fax:
Practice Address - Street 1:275 MAIN ST REAR
Practice Address - Street 2:
Practice Address - City:WEBSTER
Practice Address - State:MA
Practice Address - Zip Code:01570-2262
Practice Address - Country:US
Practice Address - Phone:508-461-9796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA777242175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA225700000XOtherIRONWORKERS UNION