Adam Robert Godfrey, SSP, NASP
Individual provider Active NPI School Psychologist · Vail, AZ
NPI 1659585404 · NPPES record last updated Jul 9, 2007
Key facts
- NPI
- 1659585404
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 3690822 (AZ)
- Practice address
- 13801 E Benson Hwy
Vail, AZ 85641-9074 - Phone
- (520) 879-2440
- NPI assigned
- May 10, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3690822 | AZ | MD | School Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 3690822 | AZ | Yes |
Addresses
Primary practice location
13801 E Benson Hwy
Vail, AZ 85641-9074
Mailing address
13801 E Benson Hwy
Vail, AZ 85641-9074
Phone (520) 879-2440
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 968224 | Medicaid | AZ |
Other providers in Vail, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 9, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.