Provider Demographics
NPI:1972502045
Name:GODINEZ, EMILIA (LICSW)
Entity Type:Individual
Prefix:MS
First Name:EMILIA
Middle Name:
Last Name:GODINEZ
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 UNIVERSITY AVE W
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55104-4101
Mailing Address - Country:US
Mailing Address - Phone:651-647-3169
Mailing Address - Fax:651-641-1005
Practice Address - Street 1:1276 UNIVERSITY AVE W
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-4101
Practice Address - Country:US
Practice Address - Phone:651-647-3169
Practice Address - Fax:651-641-1005
Is Sole Proprietor?:No
Enumeration Date:2005-07-20
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN110531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN601316300Medicaid
6290941OtherMEDICA
ZID54GOOtherBC/BS
125282OtherU CARE
MN601316300Medicaid
125282OtherU CARE