Provider Demographics
NPI:1083024749
Name:GODWIN, RYAN E (MSW)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:E
Last Name:GODWIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1485 S SEMORAN BLVD
Mailing Address - Street 2:STE 1448
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32792-5533
Mailing Address - Country:US
Mailing Address - Phone:321-397-3000
Mailing Address - Fax:
Practice Address - Street 1:1300 S DUNCAN DR
Practice Address - Street 2:BLDG C
Practice Address - City:TAVARES
Practice Address - State:FL
Practice Address - Zip Code:32778-4223
Practice Address - Country:US
Practice Address - Phone:352-742-6170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-04
Last Update Date:2014-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical