Individual provider Active NPI

Stephanie Godwin

  • Marriage & Family Therapist
  • San Diego, CA
National Provider Identifier
1720456536
Registry record updated Sep 10, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Marriage & Family TherapistTaxonomy code 106H00000X
License
IMF #87371 Issued in CA
Practice address
3160 Camino del Rio S Ste 304
San Diego, CA 92108-3835
Phone
(619) 819-0283
Fax
(619) 819-0284
NPI assigned
Sep 10, 2015
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 10, 2015

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Marriage & Family Therapist 106H00000X IMF #87371 CA Primary

Addresses

Primary practice location

3160 Camino del Rio S Ste 304
San Diego, CA 92108-3835

Mailing address

3160 Camino del Rio S Ste 304
San Diego, CA 92108-3835
Phone (619) 819-0283

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
IMF #87371CAMDMarriage & Family Therapist

Practice roles

OrganizationSpecialtyStatusNew patients
Aspera Therapy, LLC Marriage & Family Therapist CurrentSince Apr 20, 2021 Accepting new patients
Potentia Family Therapy, Inc. Marriage & Family Therapist Past Accepting new patients

Locations

258 Broad St
Ste 4
Red Bank, NJ 07701
Phone (732) 784-8348

Organizations & group practices 2

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

NPI Registry JSON

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

{
    "created_epoch": "1441843200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1441843200000",
    "number": "1720456536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3160 CAMINO DEL RIO S STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083835",
            "telephone_number": "619-819-0283",
            "fax_number": "619-819-0284"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3160 CAMINO DEL RIO S STE 304",
            "city": "SAN DIEGO",
            "state": "CA",
            "postal_code": "921083835",
            "telephone_number": "619-819-0283",
            "fax_number": "619-819-0284"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GODWIN",
        "first_name": "STEPHANIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-09-10",
        "last_updated": "2015-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106H00000X",
            "taxonomy_group": "",
            "desc": "Marriage & Family Therapist",
            "state": "CA",
            "license": "IMF #87371",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Diego, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.