Provider Demographics
NPI:1700172624
Name:GODFREY, THOMAS (MSW, LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:GODFREY
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3930 W CHESTER PIKE
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19073-3209
Mailing Address - Country:US
Mailing Address - Phone:401-208-6011
Mailing Address - Fax:267-350-4887
Practice Address - Street 1:3930 W CHESTER PIKE
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3209
Practice Address - Country:US
Practice Address - Phone:401-208-6011
Practice Address - Fax:267-350-4887
Is Sole Proprietor?:No
Enumeration Date:2011-06-20
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0165861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical