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General NPI Number Information
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NPI Number | 1144004458
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Entity Type | Individual
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Provider Name | JOSHUA GOODWIN
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Gender | Male
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Dates
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Enumeration Date | 08/21/2023
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Last Update Date | 08/21/2023
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Provider Practice Location Address
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Address Line | 1 ENTERPRISE DR
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City | SHELTON
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State | CT
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Zip | 06484-4631
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Country | US
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Telephone | 203-255-5078
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Fax |
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Provider Business Mailing Address
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Address Line | 53 WINTERGREEN DR
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City | EASTON
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State | CT
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Zip | 06612-2124
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Country | US
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Telephone | 305-308-8004
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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