=====================================================
General NPI Number Information
=====================================================
NPI Number | 1114271590
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | GRACE MARY GODINO MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/06/2012
-----------------------------------------------------
Last Update Date | 10/10/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 435 BIRCH RD
-----------------------------------------------------
City | BOLINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94924
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-949-7631
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 786
-----------------------------------------------------
City | BOLINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94924-0786
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-328-3880
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | 44840
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------