Kristen Lee Godenick, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

2961-57 Issued in WI

Practice address

427 W Eads Pkwy
Lawrenceburg, IN 47025-1139

Phone

(812) 537-7375

Fax

(812) 537-5271

NPI assigned

Mar 19, 2012

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Mar 2, 2017 through Mar 2, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

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• Family Success Consortium Inc

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  • NPI 1275724916
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  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1332115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1332115200000",
    "number": "1679848063",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "427 W EADS PKWY",
            "city": "LAWRENCEBURG",
            "state": "IN",
            "postal_code": "470251139",
            "telephone_number": "812-537-7375",
            "fax_number": "812-537-5271"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "427 W EADS PKWY",
            "city": "LAWRENCEBURG",
            "state": "IN",
            "postal_code": "470251139",
            "telephone_number": "812-537-7375",
            "fax_number": "812-537-5271"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODENICK",
        "first_name": "KRISTEN",
        "middle_name": "LEE",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-03-19",
        "last_updated": "2012-03-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "WI",
            "license": "2961-57",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• George's Family Pharmacy, Inc.
• Rachel Jane Geruc
• Harbans S Gill, M.D.
• Ashley Anne Gilland, CADC, CADAC II
• Leslie H Glick, MD
• David Goldstein
• Kara Joy Goode, MSW, LSW
• Goodman Lostutter LLC (Pine Knoll Assisted Living Center)
• Bernadette Gray, FNP
• Milton James Gray, PT

• Psychologist in Lawrenceburg, IN
• Providers in Lawrenceburg, IN by specialty
• Psychologist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.