Healthcare Provider Details

I. General information

NPI: 1013992064
Provider Name (Legal Business Name): PATRICE E GOODKIND MSW, LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 OPPENHEIMER DR SUITE 200
LOS ALAMOS NM
87544-2384
US

IV. Provider business mailing address

5040 CARRIAGE HOUSE
LOS ALAMOS NM
87544-3769
US

V. Phone/Fax

Practice location:
  • Phone: 505-662-4663
  • Fax: 505-662-4637
Mailing address:
  • Phone: 505-662-4637
  • Fax: 505-662-4637

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI-4297
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: