Provider Demographics
NPI:1902459068
Name:GODIN, ANNA PEAKE (MSW-CC)
Entity Type:Individual
Prefix:
First Name:ANNA
Middle Name:PEAKE
Last Name:GODIN
Suffix:
Gender:F
Credentials:MSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 WILD ROSE AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-6619
Mailing Address - Country:US
Mailing Address - Phone:207-671-1519
Mailing Address - Fax:
Practice Address - Street 1:15 SAUNDERS WAY STE 900
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-4836
Practice Address - Country:US
Practice Address - Phone:207-878-9663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-18
Last Update Date:2019-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMC18082OtherLICENSE