Ida Blan Goodwine, LMSW

Primary specialty

Social WorkerTaxonomy code 104100000X

License

028031-1 Issued in NY

Practice address

220 Beach 87TH St
Rockaway Beach, NY 11693-1604

Phone

(718) 318-6536

Fax

(718) 318-6597

NPI assigned

Sep 16, 2007

Last updated

Sep 16, 2007By the provider in NPPES

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 names 1

• Ms. Ida Freeman Goodwine Professional name

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": "1189900800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1189900800000",
    "number": "1629264346",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "220 BEACH 87TH ST",
            "city": "ROCKAWAY BEACH",
            "state": "NY",
            "postal_code": "116931604",
            "telephone_number": "718-318-6536",
            "fax_number": "718-318-6597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 BEACH 87TH ST",
            "city": "ROCKAWAY BEACH",
            "state": "NY",
            "postal_code": "116931604",
            "telephone_number": "718-318-6536",
            "fax_number": "718-318-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODWINE",
        "first_name": "IDA",
        "middle_name": "BLAN",
        "name_prefix": "Ms.",
        "credential": "LMSW",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-09-16",
        "last_updated": "2007-09-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "NY",
            "license": "028031-1",
            "primary": true
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "IDA",
            "last_name": "FREEMAN GOODWINE",
            "prefix": "MS.",
            "credential": "LMSW",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

• Alicia Jane Fry, LMSW
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• Marcos Garcia
• Geraldine Vicki Goldman, CRC
• Kimberly Goris
• GR Pharmacy Inc
• Elliot Green, REGISTERED NURSE
• Shaniqua Green
• Nicole Vera Griffin, MSED

• Social Worker in Rockaway Beach, NY
• Providers in Rockaway Beach, NY by specialty
• Social Worker in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 16, 2007; 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.