Provider Demographics
NPI:1134239486
Name:GODFREY, ELISSA MAY
Entity type:Individual
Prefix:DR
First Name:ELISSA
Middle Name:MAY
Last Name:GODFREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8119 HOLLAND RD
Mailing Address - Street 2:MT VERNON CENTER
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22306-0000
Mailing Address - Country:US
Mailing Address - Phone:703-360-6910
Mailing Address - Fax:703-360-0899
Practice Address - Street 1:8119 HOLLAND RD
Practice Address - Street 2:MT VERNON CENTER
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22306-3135
Practice Address - Country:US
Practice Address - Phone:703-360-6910
Practice Address - Fax:703-360-0899
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2013-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA01010457682084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry