Provider Demographics
NPI:1164782181
Name:GOODWIN, ELIZABETH K (LICSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:K
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:K
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:511 28TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4161
Mailing Address - Country:US
Mailing Address - Phone:206-290-3221
Mailing Address - Fax:
Practice Address - Street 1:511 28TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4161
Practice Address - Country:US
Practice Address - Phone:206-290-3221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-23
Last Update Date:2012-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW 602372561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical