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NPI Code Detail

MEDICARE: CARA GOODWIN

MEDICARE: CARA GOODWIN
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
1103TC0700XClinical Psychologist0810005784VA

General Provider Information

NPI Number : 1669990008
Entity Type Code : Individual
Provider Name (Legal Business Name) : CARA GOODWIN
Provider Business Mailing Address
First Line : 1655 OWENSVILLE RD
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-9407
Country : US
Telephone Number : 314-882-0581
Fax Number :
Provider Business Practice Location Address
First Line : 3500 REMSON CT
Second Line :
City : CHARLOTTESVILLE
State : VA
Zip : 22901-3508
Country : US
Telephone Number : 434-923-8252
Fax Number : 434-282-2180
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/06/2017
Last Update Date : 09/06/2017

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Directions to “ CARA GOODWIN ” Practice Location

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