Healthcare Provider Details

I. General information

NPI: 1104713270
Provider Name (Legal Business Name): LEAH GOODWIN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/21/2025
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6803 LAKE WORTH RD # 215
GREENACRES FL
33467-2979
US

IV. Provider business mailing address

6803 LAKE WORTH RD # 215
GREENACRES FL
33467-2979
US

V. Phone/Fax

Practice location:
  • Phone: 407-969-8372
  • Fax:
Mailing address:
  • Phone: 407-969-8372
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH27700
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: