Provider Demographics
NPI:1053660803
Name:JACOBSON-GOODHUE, NOAH (LICSW)
Entity Type:Individual
Prefix:
First Name:NOAH
Middle Name:
Last Name:JACOBSON-GOODHUE
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 249
Mailing Address - Street 2:
Mailing Address - City:HARTLAND
Mailing Address - State:VT
Mailing Address - Zip Code:05048-0249
Mailing Address - Country:US
Mailing Address - Phone:802-299-0451
Mailing Address - Fax:
Practice Address - Street 1:20 W PARK ST STE 426
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1378
Practice Address - Country:US
Practice Address - Phone:802-299-0451
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2019-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH22111041C0700X
VT089-00012041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical