Healthcare Provider Details

I. General information

NPI: 1447752118
Provider Name (Legal Business Name): KELLY GOEDEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2018
Last Update Date: 02/19/2025
Certification Date: 02/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 OSTEEN RD
NEW PORT RICHEY FL
34653-2324
US

IV. Provider business mailing address

7710 OSTEEN RD
NEW PORT RICHEY FL
34653-2324
US

V. Phone/Fax

Practice location:
  • Phone: 727-264-6497
  • Fax:
Mailing address:
  • Phone: 727-264-6497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW22608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: