Provider Demographics
NPI:1093973398
Name:GOODINE, BRENDA R (MHRT-C)
Entity Type:Individual
Prefix:
First Name:BRENDA
Middle Name:R
Last Name:GOODINE
Suffix:
Gender:F
Credentials:MHRT-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 VICKERS DR
Mailing Address - Street 2:
Mailing Address - City:CARIBOU
Mailing Address - State:ME
Mailing Address - Zip Code:04736-3884
Mailing Address - Country:US
Mailing Address - Phone:207-498-0922
Mailing Address - Fax:207-492-3181
Practice Address - Street 1:43 VICKERS DR
Practice Address - Street 2:
Practice Address - City:CARIBOU
Practice Address - State:ME
Practice Address - Zip Code:04736-3884
Practice Address - Country:US
Practice Address - Phone:207-498-0922
Practice Address - Fax:207-492-3181
Is Sole Proprietor?:No
Enumeration Date:2008-05-23
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME103850000OtherMAINECARE