Provider Demographics
NPI:1457095200
Name:GODFREY, CARMON JOCELYNN (BCBA)
Entity type:Individual
Prefix:
First Name:CARMON
Middle Name:JOCELYNN
Last Name:GODFREY
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 W MAIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:CROSBY
Mailing Address - State:MN
Mailing Address - Zip Code:56441-1490
Mailing Address - Country:US
Mailing Address - Phone:218-353-5472
Mailing Address - Fax:
Practice Address - Street 1:101 W MAIN ST STE B
Practice Address - Street 2:
Practice Address - City:CROSBY
Practice Address - State:MN
Practice Address - Zip Code:56441-1490
Practice Address - Country:US
Practice Address - Phone:218-353-5472
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician