Provider Demographics
NPI:1558849364
Name:GODKIN, MIRIAM
Entity type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:
Last Name:GODKIN
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 1:183 CALLE MAGDALENA STE 101
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3793
Mailing Address - Country:US
Mailing Address - Phone:858-382-0870
Mailing Address - Fax:
Practice Address - Street 1:183 CALLE MAGDALENA STE 101
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-3793
Practice Address - Country:US
Practice Address - Phone:858-382-0870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC52362106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
$$$$$$$$$OtherNO OTHER NUMBERS