Provider Demographics
NPI:1902690845
Name:GOODELL, SHAE JK
Entity type:Individual
Prefix:MRS
First Name:SHAE
Middle Name:JK
Last Name:GOODELL
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 882
Mailing Address - Street 2:
Mailing Address - City:STODDARD
Mailing Address - State:NH
Mailing Address - Zip Code:03464-0882
Mailing Address - Country:US
Mailing Address - Phone:603-831-3238
Mailing Address - Fax:
Practice Address - Street 1:2 MECHANIC ST UNIT 1-6
Practice Address - Street 2:
Practice Address - City:EASTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01027-1562
Practice Address - Country:US
Practice Address - Phone:413-540-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-07
Last Update Date:2025-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor