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General NPI Number Information
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NPI Number | 1003810664
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Entity Type | Individual
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Provider Name | JACQUELINE H GOODIN LISW
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Gender | Female
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Dates
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Enumeration Date | 06/10/2005
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3430 ROCKY RIVER DR
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City | CLEVELAND
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State | OH
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Zip | 44111-2954
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Country | US
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Telephone | 216-688-1111
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Fax | 216-251-2886
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Provider Business Mailing Address
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Address Line | 1439 MARLOWE AVE
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City | LAKEWOOD
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State | OH
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Zip | 44107-4318
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Country | US
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Telephone | 216-226-6851
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | I5454
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License Number State | OH
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