Basic Information
| Provider Information | |||||||||
| NPI: | 1184996688 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | JOVANELLY GODFREY | ||||||||
| FirstName: | DANIELLE | ||||||||
| MiddleName: | G | ||||||||
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| Mailing Information | |||||||||
| Address1: | 815 N EL CENTRO AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900383805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234632119 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 815 N EL CENTRO AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900383805 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3234632119 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/31/2012 | ||||||||
| LastUpdateDate: | 02/06/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | ASW32185 | WA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 1041C0700X | 81552 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.