Provider Demographics
NPI:1588955595
Name:GODOY, ELAINE MARIE
Entity type:Individual
Prefix:MISS
First Name:ELAINE
Middle Name:MARIE
Last Name:GODOY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:201 E CENTER ST STE 112-3755
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-7204
Mailing Address - Country:US
Mailing Address - Phone:562-351-3595
Mailing Address - Fax:
Practice Address - Street 1:201 E CENTER ST STE 112-3755
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-7204
Practice Address - Country:US
Practice Address - Phone:562-351-3595
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2024-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA99022106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist