Provider Demographics
NPI:1871391862
Name:GODFREY, JACQUELINE GANZ
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:GANZ
Last Name:GODFREY
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:POSTNET 9909 TOPANGA CANOGA BLVD.
Mailing Address - Street 2:#260
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5510
Mailing Address - Country:US
Mailing Address - Phone:818-378-3053
Mailing Address - Fax:
Practice Address - Street 1:POSTNET 9909 TOPANGA CANOGA BLVD.
Practice Address - Street 2:#260
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-5510
Practice Address - Country:US
Practice Address - Phone:818-378-3053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-05
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician