Provider Demographics
NPI:1871089060
Name:GODIN, SANDRA JEANNE (LPC)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:JEANNE
Last Name:GODIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:344 WOLCOTT ST
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:CT
Mailing Address - Zip Code:06010-6427
Mailing Address - Country:US
Mailing Address - Phone:860-805-0775
Mailing Address - Fax:
Practice Address - Street 1:53 MUIR AVE
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:CT
Practice Address - Zip Code:06010-7215
Practice Address - Country:US
Practice Address - Phone:860-582-7904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-10
Last Update Date:2018-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3490101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional