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General NPI Number Information
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NPI Number | 1811218571
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Entity Type | Individual
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Provider Name | CARL LESLIE GOODWIN-MOORE LMSW-CC
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Gender | Male
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Dates
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Enumeration Date | 06/17/2010
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Last Update Date | 06/17/2010
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Provider Practice Location Address
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Address Line | 9 FIELD ST SUITE 434
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City | BELFAST
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State | ME
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Zip | 04915-6661
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Country | US
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Telephone | 207-338-8960
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Fax | 207-338-8962
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Provider Business Mailing Address
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Address Line | PO BOX 570
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City | LINCOLNVILLE
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State | ME
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Zip | 04849-0570
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Country | US
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Telephone | 207-323-5143
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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 | MC12409
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License Number State | ME
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