Provider Demographics
NPI:1043909146
Name:GODDARD, JOHN D (MS, EDD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:D
Last Name:GODDARD
Suffix:
Gender:M
Credentials:MS, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 WERTZVILLE RD
Mailing Address - Street 2:
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1158
Mailing Address - Country:US
Mailing Address - Phone:717-438-4878
Mailing Address - Fax:
Practice Address - Street 1:6035 WERTZVILLE RD
Practice Address - Street 2:
Practice Address - City:ENOLA
Practice Address - State:PA
Practice Address - Zip Code:17025-1158
Practice Address - Country:US
Practice Address - Phone:717-438-4878
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-04
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral