Healthcare Provider Details

I. General information

NPI: 1447414719
Provider Name (Legal Business Name): JOSEPHINE CECILIA BECKLEY GOODMAN MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: JOANNA BECKLEY BECKLEY-GOODMAN MSW

II. Dates (important events)

Enumeration Date: 07/15/2008
Last Update Date: 12/03/2020
Certification Date: 12/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4033 E MADISON ST SUITE 100
SEATTLE WA
98112-3104
US

IV. Provider business mailing address

4033 E MADISON ST STE 204
SEATTLE WA
98112-3104
US

V. Phone/Fax

Practice location:
  • Phone: 206-322-7118
  • Fax:
Mailing address:
  • Phone: 206-322-7118
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00007457
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLW00007457
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: