Healthcare Provider Details

I. General information

NPI: 1497304315
Provider Name (Legal Business Name): FEDERICO GODINA LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/04/2019
Last Update Date: 07/16/2024
Certification Date: 07/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

190 TOWNSITE PROMENADE
CAMARILLO CA
93010-7582
US

IV. Provider business mailing address

2046 ALLEN AVE RM 100
ALTADENA CA
91001-3424
US

V. Phone/Fax

Practice location:
  • Phone: 805-312-0777
  • Fax:
Mailing address:
  • Phone: 626-396-5920
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number120906
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: