Provider Demographics
NPI:1770306326
Name:GODINEZ, MARCO AURELIO (LMFT)
Entity type:Individual
Prefix:MR
First Name:MARCO
Middle Name:AURELIO
Last Name:GODINEZ
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2511 SHADOWBROOKE RD
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-5557
Mailing Address - Country:US
Mailing Address - Phone:925-565-6242
Mailing Address - Fax:
Practice Address - Street 1:2511 SHADOWBROOKE RD
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-5557
Practice Address - Country:US
Practice Address - Phone:925-565-6242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-11-04
Last Update Date:2024-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148586106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist