Healthcare Provider Details

I. General information

NPI: 1932696564
Provider Name (Legal Business Name): DEENA GODFREY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2018
Last Update Date: 07/16/2025
Certification Date: 07/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

175 CAMBRIDGE ST RM 591
BOSTON MA
02114-2743
US

IV. Provider business mailing address

125 NASHUA ST STE 260
BOSTON MA
02114-1109
US

V. Phone/Fax

Practice location:
  • Phone: 617-726-2687
  • Fax:
Mailing address:
  • Phone: 617-724-4133
  • Fax: 617-724-3947

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0301X
TaxonomyBrain Injury Medicine (Psychiatry & Neurology) Physician
License Number1014532
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number1014532
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: