=====================================================
General NPI Number Information
=====================================================
NPI Number | 1639203243
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CITY OF MERCER ISLAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 09/11/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2040 84TH AVE SE
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-236-3525
-----------------------------------------------------
Fax | 206-236-3632
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2040 84TH AVE SE
-----------------------------------------------------
City | MERCER ISLAND
-----------------------------------------------------
State | WA
-----------------------------------------------------
Zip | 98040
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 206-236-3525
-----------------------------------------------------
Fax | 206-236-3632
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | MS. CYNTHIA COREY GOODWIN
-----------------------------------------------------
Credential | MSW
-----------------------------------------------------
Telephone | 206-236-3535
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 104100000X
-----------------------------------------------------
Taxonomy Name | Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------