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General NPI Number Information
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NPI Number | 1407735517
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Entity Type | Individual
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Provider Name | TRACY GOODWIN
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Gender | Female
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Dates
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Enumeration Date | 09/02/2025
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Last Update Date | 09/02/2025
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Provider Practice Location Address
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Address Line | 4351 58TH AVE
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City | BLADENSBURG
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State | MD
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Zip | 20710-1900
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Country | US
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Telephone | 703-629-1250
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Fax |
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Provider Business Mailing Address
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Address Line | 8908 RIGGS RD
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City | ADELPHI
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State | MD
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Zip | 20783-1632
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Country | US
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Telephone |
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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 | 103TS0200X
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Taxonomy Name | School Psychologist
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License Number | 92194B9L8Z1
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License Number State | MD
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