Healthcare Provider Details

I. General information

NPI: 1578541298
Provider Name (Legal Business Name): LYNN GODMILOW MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/03/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 SPRUCE ST ROOM 538 MALONEY BUILDING
PHILADELPHIA PA
19104-4206
US

IV. Provider business mailing address

630 S BOWMAN AVE
MERION STATION PA
19066-1421
US

V. Phone/Fax

Practice location:
  • Phone: 215-662-4740
  • Fax: 215-614-0298
Mailing address:
  • Phone: 610-667-5866
  • Fax: 610-660-9292

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code170300000X
TaxonomyGenetic Counselor (M.S.)
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: