Provider Demographics
NPI:1598317901
Name:GOODWIN, SUSAN M (LCADC)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FORREST HILL DR
Mailing Address - Street 2:
Mailing Address - City:HOWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07731-2104
Mailing Address - Country:US
Mailing Address - Phone:732-688-9377
Mailing Address - Fax:
Practice Address - Street 1:17 FORREST HILL DR
Practice Address - Street 2:
Practice Address - City:HOWELL
Practice Address - State:NJ
Practice Address - Zip Code:07731-2104
Practice Address - Country:US
Practice Address - Phone:732-688-9377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-15
Last Update Date:2019-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00298900101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty