Provider Demographics
NPI:1194839829
Name:GOODEN, ANNE HANEY (MA, MSW)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:HANEY
Last Name:GOODEN
Suffix:
Gender:F
Credentials:MA, MSW
Other - Prefix:MRS
Other - First Name:ANNE
Other - Middle Name:H
Other - Last Name:GOODEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA, MSW
Mailing Address - Street 1:230 S EL VOLADOR
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85711-3432
Mailing Address - Country:US
Mailing Address - Phone:520-325-7965
Mailing Address - Fax:
Practice Address - Street 1:5920 E PIMA ST
Practice Address - Street 2:140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4306
Practice Address - Country:US
Practice Address - Phone:520-733-2524
Practice Address - Fax:520-733-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-19
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-11791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW-1179OtherLICENSURE