Provider Demographics
NPI:1407676166
Name:GOODWIN, SAMANTHA ELEANOR
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:ELEANOR
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 MIDDLE RD UNIT 70
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4864
Mailing Address - Country:US
Mailing Address - Phone:603-731-6068
Mailing Address - Fax:
Practice Address - Street 1:200 INTERNATIONAL DR STE 157
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-6833
Practice Address - Country:US
Practice Address - Phone:603-957-1877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-16
Last Update Date:2024-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty