Active NPI
Susan Windham Goodwyn, PH.D.
- Clinical Psychologist
- Vacaville, CA
National Provider Identifier
1003106279
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY24190
- Practice address
- 301 Alamo Dr
A1
Vacaville, CA 95688-4246 - Phone
- (707) 455-8541
- Fax
- (707) 455-7435
- NPI assigned
- Apr 8, 2011
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY24190 | CA | Primary |
Addresses
Primary practice location
301 Alamo Dr
A1
Vacaville, CA 95688-4246
Mailing address
3358 Mix Canyon Rd
Vacaville, CA 95688-9012
Phone (707) 455-8541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20110606000438 | CA | Practitioner - Psychologist Billing Independently | 1658558317 | Practice locations: Vacaville, CA |
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- Other, 1986
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Telehealth
- Offers telehealth services
Practice addresses (Care Compare)
3358 Mix Canyon Rd
Vacaville, CA 95688-9012
Phone (707) 592-9556
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY24190 | CA | MD | Clinical Psychologist |
| 24190 | CA | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1302220800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1302652800000",
"number": "1003106279",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3358 MIX CANYON RD",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956889012",
"telephone_number": "707-455-8541",
"fax_number": "707-455-7435"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 ALAMO DR",
"address_2": "A1",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956884246",
"telephone_number": "707-455-8541",
"fax_number": "707-455-7435"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODWYN",
"first_name": "SUSAN",
"middle_name": "WINDHAM",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-04-08",
"last_updated": "2011-04-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY24190",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.