Mary Petrina Goodwin, LCSW, LCAS-A

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

C010557 Issued in NC

Practice address

3825 Market St Ste 4
Wilmington, NC 28403-1426

Phone

(910) 777-5575

Fax

(910) 777-5273

NPI assigned

Apr 24, 2015

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Other names 1

• Mary Smithe Former name

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Social Worker

Education

Other, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Capeside Psychiatry PLLCGroup PAC ID 5991926560, 11 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Capeside Psychiatry, PLLC

  • Psychiatry Physician
  • Wilmington, NC
  • NPI 1760891980
  Medicare reassignment Care Compare group NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1922022607
  Medicare reassignment NPD
• Rha Health Services Inc

  • Community/Behavioral Health Agency
  • Concord, NC
  • NPI 1447376306
  Medicare reassignment NPD
• Grow Healthcare Group PA

  • Mental Health Counselor
  • Miami, FL
  • NPI 1245845932

  Clinical, NC

  Medicare reassignment NPD
• Coastal Horizons Center Inc

  • Community/Behavioral Health Agency
  • Rocky Point, NC
  • NPI 1063082592
  NPD
• Coastal Horizons Center, Inc

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1033420153
  NPD
• Coastal Horizons Center, Inc.

  • Community/Behavioral Health Agency
  • Wilmington, NC
  • NPI 1790985448
  NPD
• Rha Health Services Inc

  • Community/Behavioral Health Agency
  • Burnsville, NC
  • NPI 1316273428
  NPD
• Rha Health Services, Inc

  • Community/Behavioral Health Agency
  • Yanceyville, NC
  • NPI 1629489307
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1429833600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1651795200000",
    "number": "1124415302",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3825 MARKET ST STE 4",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031426",
            "telephone_number": "910-777-5575",
            "fax_number": "910-777-5273"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3825 MARKET ST STE 4",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284031426",
            "telephone_number": "910-777-5575",
            "fax_number": "910-777-5273"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWIN",
        "first_name": "MARY",
        "middle_name": "PETRINA",
        "credential": "LCSW, LCAS-A",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2015-04-24",
        "last_updated": "2022-05-06",
        "certification_date": "2022-05-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NC",
            "license": "C010557",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "NC",
            "license": "C010557",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1124415302",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "https://www.wilmingtonmentalhealth.com",
            "affiliation": "N",
            "endpointDescription": "Website",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "OTHER",
            "contentTypeDescription": "Other",
            "contentOtherDescription": "Website",
            "address_1": "3825 Market St Ste 4",
            "city": "Wilmington",
            "state": "NC",
            "country_code": "US",
            "postal_code": "284031426",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARY",
            "last_name": "SMITHE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Alexandra Nicole Goodman
• Matthew Goodnight, LCMHC
• Cassandra Goodson, LMBT
• James Gregg Goodwin, MA
• Kristen Joy Goodwin
• Erin Elizabeth Gora, LCSW
• Michelle Gorbaty, MD
• Diana Gorder, DPT
• Kevin Gorder, DPT
• Kelly Gordon-Wylie, LCSW-A

• Clinical Social Worker in Wilmington, NC
• Providers in Wilmington, NC by specialty
• Clinical Social Worker in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• 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.

Verify at the official NPI Registry.