Gary D. Goodwin, LCSW
Individual provider Active NPI Clinical Social Worker · Snowflake, AZ
NPI 1760873004 · NPPES record last updated Feb 9, 2015
Key facts
- NPI
- 1760873004
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- LCSW 15444 (AZ)
- Practice address
- 440 S 2ND St W
Snowflake, AZ 85937-5218 - Phone
- (928) 243-8172
- NPI assigned
- Feb 9, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| LCSW 15444 | AZ | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | LCSW 15444 | AZ | Yes |
Addresses
Primary practice location
440 S 2ND St W
Snowflake, AZ 85937-5218
Mailing address
440 S 2ND St W
Snowflake, AZ 85937-5218
Phone (928) 243-8172
Other providers in Snowflake, AZ
- Eagledancer Youth and Family Services, Inc.
- Lorraine Ferrante
- James Scott Flake
- Connie Kaye Gardner
- Jacquelyn Leah Garrett Allen
- Gwendolyn Lee Hall CNM Inc
- Gwendolyn Lee Hall, CNM
- Wendy Lee Hall
- Michelle Hardesty
- Hatch Haven, LLC
All providers in Snowflake, AZ · Clinical Social Worker in Arizona
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 9, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.