Provider Demographics
NPI:1235887456
Name:GOODWIN, CHLOE (LMSW)
Entity Type:Individual
Prefix:
First Name:CHLOE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 OLD SANTA FE TRL STE 1
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87505-0398
Mailing Address - Country:US
Mailing Address - Phone:505-927-7092
Mailing Address - Fax:
Practice Address - Street 1:346 EAGLE DR
Practice Address - Street 2:
Practice Address - City:OHKAY OWINGEH
Practice Address - State:NM
Practice Address - Zip Code:87566-3600
Practice Address - Country:US
Practice Address - Phone:505-927-7092
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-16
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-12114104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker