Provider Demographics
NPI:1598060006
Name:GODAR, JENNIFER LORRAINE (PSYD, HSPP)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LORRAINE
Last Name:GODAR
Suffix:
Gender:F
Credentials:PSYD, HSPP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11350 N MERIDIAN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-3531
Mailing Address - Country:US
Mailing Address - Phone:317-975-1896
Mailing Address - Fax:317-805-1087
Practice Address - Street 1:11350 N MERIDIAN ST STE 300
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-3531
Practice Address - Country:US
Practice Address - Phone:317-975-1896
Practice Address - Fax:317-805-1087
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-13
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN20042481A103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical