Healthcare Provider Details

I. General information

NPI: 1902024870
Provider Name (Legal Business Name): MARY CATHERINE GOOLSBY LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY CATHERINE DICKEY LMSW-CC

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

313 ENFIELD RD.
LINCOLN ME
04457
US

IV. Provider business mailing address

PO BOX 789
LINCOLN ME
04457-0789
US

V. Phone/Fax

Practice location:
  • Phone: 207-794-3559
  • Fax: 207-794-3814
Mailing address:
  • Phone: 207-732-6259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC6921
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: