Active NPI
Joaquim L. Godfrey
- School Psychologist
- Country Club Hills, IL
National Provider Identifier
1790295178
On this page
Key facts
NPPES NPI Registry- Primary specialty
- School Psychologist
- Practice address
- 4036 Cambridge Dr
Country Club Hills, IL 60478-7001 - Phone
- (708) 799-6064
- NPI assigned
- Oct 11, 2017
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | Primary |
Addresses
Primary practice location
4036 Cambridge Dr
Country Club Hills, IL 60478-7001
Mailing address
4036 Cambridge Dr
Country Club Hills, IL 60478-7001
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1507680000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507680000000",
"number": "1790295178",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4036 CAMBRIDGE DR",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604787001"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4036 CAMBRIDGE DR",
"city": "COUNTRY CLUB HILLS",
"state": "IL",
"postal_code": "604787001",
"telephone_number": "708-799-6064"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GODFREY",
"first_name": "JOAQUIM",
"middle_name": "L.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2017-10-11",
"last_updated": "2017-10-11",
"status": "A"
},
"taxonomies": [
{
"code": "103TS0200X",
"taxonomy_group": "",
"desc": "Psychologist, School",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Country Club Hills, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.