Healthcare Provider Details

I. General information

NPI: 1235294158
Provider Name (Legal Business Name): CORENE CREE MCGOODEN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CORENE CREE BAUSERMAN LCSW

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 07/06/2022
Certification Date: 07/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ROBERTS AVE
TALLAHASSEE FL
32310-5007
US

IV. Provider business mailing address

2911 ROBERTS AVE UNIT B
TALLAHASSEE FL
32310-5007
US

V. Phone/Fax

Practice location:
  • Phone: 850-644-1543
  • Fax: 855-230-7421
Mailing address:
  • Phone: 850-644-1543
  • Fax: 855-230-7421

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW7061
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: