Provider Demographics
NPI:1174832745
Name:GOODWIN, KYLE JOSEPH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KYLE
Middle Name:JOSEPH
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2737 W FAIRBANKS AVE
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-3314
Mailing Address - Country:US
Mailing Address - Phone:407-740-6838
Mailing Address - Fax:407-740-0902
Practice Address - Street 1:2737 W FAIRBANKS AVE
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-3314
Practice Address - Country:US
Practice Address - Phone:407-740-6838
Practice Address - Fax:407-740-0902
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-30
Last Update Date:2010-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL8144103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical