Provider Demographics
NPI:1316742752
Name:MESSINA-GODFREY, MICHAEL JESUS
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JESUS
Last Name:MESSINA-GODFREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:124 PAVON
Mailing Address - Street 2:
Mailing Address - City:HERCULES
Mailing Address - State:CA
Mailing Address - Zip Code:94547-3752
Mailing Address - Country:US
Mailing Address - Phone:510-779-2334
Mailing Address - Fax:
Practice Address - Street 1:124 PAVON
Practice Address - Street 2:
Practice Address - City:HERCULES
Practice Address - State:CA
Practice Address - Zip Code:94547-3752
Practice Address - Country:US
Practice Address - Phone:510-779-2334
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-18
Last Update Date:2025-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician