Healthcare Provider Details

I. General information

NPI: 1275001646
Provider Name (Legal Business Name): CHRISTINA L. GOODWIN PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2018
Last Update Date: 05/01/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3 COOPER PLZ RM 307
CAMDEN NJ
08103
US

IV. Provider business mailing address

1 FEDERAL ST # 200
CAMDEN NJ
08103-1088
US

V. Phone/Fax

Practice location:
  • Phone: 856-342-2328
  • Fax:
Mailing address:
  • Phone: 856-356-2924
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPS01713
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPT191A006
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: