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NPI Code Detail

MEDICARE: NICOLE GOODWIN SOCIAL WORKER

MEDICARE: NICOLE GOODWIN SOCIAL WORKER
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1167G00000XLicensed Psychiatric TechnicianPT31294CA
2373H00000XDay Training/Habilitation SpecialistCA

General Provider Information

NPI Number : 1902964398
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE GOODWIN SOCIAL WORKER
Provider Business Mailing Address
First Line : 784 HIGH ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-5243
Country : US
Telephone Number : 805-540-6500
Fax Number :
Provider Business Practice Location Address
First Line : 784 HIGH ST
Second Line :
City : SAN LUIS OBISPO
State : CA
Zip : 93401-5243
Country : US
Telephone Number : 805-540-6500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/05/2006
Last Update Date : 10/21/2025

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Directions to “ NICOLE GOODWIN SOCIAL WORKER” Practice Location

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