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General NPI Number Information
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NPI Number | 1538399480
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Entity Type | Individual
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Provider Name | ELISABETH MEGAN GOODWIN PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 07/24/2009
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Last Update Date | 04/03/2015
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Provider Practice Location Address
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Address Line | 727 INDUSTRIAL RD STE 104
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City | SAN CARLOS
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State | CA
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Zip | 94070-3390
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Country | US
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Telephone | 650-204-1370
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1124
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City | BURLINGAME
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State | CA
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Zip | 94011-1124
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Country | US
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Telephone | 831-277-3852
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 24453
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License Number State | CA
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