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NPI Code Detail

MEDICARE: MS. GALA PATRICE GOODWIN LCSW

MEDICARE: MS. GALA PATRICE GOODWIN LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social Worker15367CA

General Provider Information

NPI Number : 1437268166
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. GALA PATRICE GOODWIN LCSW
Provider Business Mailing Address
First Line : 2020 CREEKSIDE RD
Second Line :
City : SANTA ROSA
State : CA
Zip : 95405-8019
Country : US
Telephone Number : 707-360-1505
Fax Number : 707-576-7243
Provider Business Practice Location Address
First Line : 341 IRWIN LN
Second Line :
City : SANTA ROSA
State : CA
Zip : 95401-5603
Country : US
Telephone Number : 707-360-1500
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/29/2006
Last Update Date : 07/08/2007

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