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General NPI Number Information
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NPI Number | 1568918647
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Entity Type | Individual
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Provider Name | BRENDA GODINEZ
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Gender | Female
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Dates
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Enumeration Date | 08/29/2016
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Last Update Date | 05/07/2025
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Provider Practice Location Address
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Address Line | 201 S HARBOR BLVD
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City | LA HABRA
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State | CA
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Zip | 90631-5654
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Country | US
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Telephone | 562-264-6000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2734
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City | BASSETT
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State | CA
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Zip | 91746-0734
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Country | US
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Telephone | 626-347-4534
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | ASW71874
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LCSW88306
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | ASW71874
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License Number State | CA
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