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General NPI Number Information
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NPI Number | 1962027797
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Entity Type | Organization
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Legal Business Name | REGINA GOODMAN, L.C.S.W., LLC
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Dates
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Enumeration Date | 06/08/2020
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Last Update Date | 07/15/2022
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Provider Practice Location Address
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Address Line | 777 N JEFFERSON ST STE 402
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City | MILWAUKEE
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State | WI
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Zip | 53202-3713
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Country | US
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Telephone | 414-502-9245
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Fax |
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Provider Business Mailing Address
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Address Line | 777 N JEFFERSON ST STE 402
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City | MILWAUKEE
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State | WI
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Zip | 53202-3713
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Country | US
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Telephone | 414-502-9245
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | REGINA GOODMAN
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Credential | LCSW
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Telephone | 414-828-3634
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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 |
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License Number State |
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