Provider Demographics
NPI:1780252999
Name:GODMAN PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:GODMAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD, CCHP-MH
Authorized Official - Phone:917-873-0759
Mailing Address - Street 1:4231 BALBOA AVE # 1256
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92117-5504
Mailing Address - Country:US
Mailing Address - Phone:917-873-0759
Mailing Address - Fax:
Practice Address - Street 1:1048 BENITO AVE
Practice Address - Street 2:
Practice Address - City:PACIFIC GROVE
Practice Address - State:CA
Practice Address - Zip Code:93950-5404
Practice Address - Country:US
Practice Address - Phone:917-873-0759
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-14
Last Update Date:2021-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)