MEDICARE: ALYSSA MARIA GODEK

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	IMH24709	FL

General Provider Information

NPI Number	:	1083452072
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALYSSA MARIA GODEK

Provider Business Mailing Address
First Line	:	6772 ROUNDLEAF DR
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32258-5503
Country	:	US
Telephone Number	:	352-342-1350
Fax Number	:

Provider Business Practice Location Address
First Line	:	7807 BAYMEADOWS RD E STE 402
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32256-9668
Country	:	US
Telephone Number	:	904-799-2800
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/16/2024
Last Update Date	:	07/16/2024

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Directions to “ ALYSSA MARIA GODEK ” Practice Location

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