Provider Demographics
NPI:1205193869
Name:GOEDEKER, CARA E (LCSW)
Entity Type:Individual
Prefix:
First Name:CARA
Middle Name:E
Last Name:GOEDEKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 NOYES ST
Mailing Address - Street 2:- YORK STREET
Mailing Address - City:UTICA
Mailing Address - State:NY
Mailing Address - Zip Code:13502-3854
Mailing Address - Country:US
Mailing Address - Phone:315-738-4440
Mailing Address - Fax:315-738-4410
Practice Address - Street 1:1400 NOYES ST
Practice Address - Street 2:- YORK STREET
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13502-3854
Practice Address - Country:US
Practice Address - Phone:315-738-4440
Practice Address - Fax:315-738-4410
Is Sole Proprietor?:No
Enumeration Date:2012-04-19
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
NY730827341041C0700X
NY72082268104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1295175867OtherAGENCY NPI