Healthcare Provider Details

I. General information

NPI: 1033463849
Provider Name (Legal Business Name): MARY GOGGINS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/31/2012
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17445 W EAGLE CT
GOODYEAR AZ
85338-3019
US

IV. Provider business mailing address

17445 W EAGLE CT
GOODYEAR AZ
85338-3019
US

V. Phone/Fax

Practice location:
  • Phone: 608-709-9838
  • Fax:
Mailing address:
  • Phone: 608-709-9838
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number15722-131
License Number StateWI
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number155268
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number19455
License Number StateAZ
# 4
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCSW09928838
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number680114469
License Number StateMI
# 6
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06202100
License Number StateNJ
# 7
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number7947-123
License Number StateWI
# 8
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW20949
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: