Healthcare Provider Details

I. General information

NPI: 1295228989
Provider Name (Legal Business Name): CATLIN BROOKE GOODWIN MSW LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2018
Last Update Date: 06/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

302 W MAIN ST
SAINT CLAIRSVILLE OH
43950-8801
US

IV. Provider business mailing address

125 EDGWOOD ST
WHEELING WV
26003-6093
US

V. Phone/Fax

Practice location:
  • Phone: 740-968-7006
  • Fax:
Mailing address:
  • Phone: 304-807-6442
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1802372
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: