Gennifer Michelle Goodloe, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

CSW007128 Issued in GA

Practice address

2916 Clairmont Rd NE
Brookhaven, GA 30329-4441

Phone

(312) 257-9500

NPI assigned

Jan 4, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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

{
    "created_epoch": "1609718400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1609718400000",
    "number": "1245828409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2916 CLAIRMONT RD NE APT 3212",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303294492",
            "telephone_number": "312-257-9500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2916 CLAIRMONT RD NE",
            "city": "BROOKHAVEN",
            "state": "GA",
            "postal_code": "303294441",
            "telephone_number": "312-257-9500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODLOE",
        "first_name": "GENNIFER",
        "middle_name": "MICHELLE",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-01-04",
        "last_updated": "2021-01-04",
        "certification_date": "2020-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IL",
            "license": "149018751",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "GA",
            "license": "CSW007128",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Global Reliable Transportation
• Candice Glover, FNP-C
• Florie Glusman, OTR/L
• David Goldstrom, LMFT
• Iesha Ranae Gonder
• Amani Kasumi Gordon, DDS
• Hayley Christine- Louise Gordon, MS , BCBA
• Hunter Fillmore Graham, BA, RBT
• Amy Graves, MA
• Fiona Graves, PMHNP

• Clinical Social Worker in Brookhaven, GA
• Providers in Brookhaven, GA by specialty
• Clinical Social Worker in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.