Provider Demographics
NPI:1902024870
Name:GOOLSBY, MARY CATHERINE (LCSW)
Entity type:Individual
Prefix:
First Name:MARY
Middle Name:CATHERINE
Last Name:GOOLSBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:MARY
Other - Middle Name:CATHERINE
Other - Last Name:DICKEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:PO BOX 789
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:ME
Mailing Address - Zip Code:04457-0789
Mailing Address - Country:US
Mailing Address - Phone:207-732-6259
Mailing Address - Fax:
Practice Address - Street 1:313 ENFIELD RD.
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:ME
Practice Address - Zip Code:04457
Practice Address - Country:US
Practice Address - Phone:207-794-3559
Practice Address - Fax:207-794-3814
Is Sole Proprietor?:No
Enumeration Date:2007-04-23
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC69211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical