Provider Demographics
NPI:1235294158
Name:MCGOODEN, CORENE CREE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:CORENE
Middle Name:CREE
Last Name:MCGOODEN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CORENE
Other - Middle Name:CREE
Other - Last Name:BAUSERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:2911 ROBERTS AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32310-5007
Mailing Address - Country:US
Mailing Address - Phone:850-644-1543
Mailing Address - Fax:855-230-7421
Practice Address - Street 1:2911 ROBERTS AVE
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32310-5007
Practice Address - Country:US
Practice Address - Phone:850-644-1543
Practice Address - Fax:855-230-7421
Is Sole Proprietor?:No
Enumeration Date:2006-12-22
Last Update Date:2022-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW70611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767960200Medicaid