Provider Demographics
NPI:1245764067
Name:GOODWIN, CARMELINE (LSCSW, LCSW, RPT)
Entity Type:Individual
Prefix:
First Name:CARMELINE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LSCSW, LCSW, RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 SHAWNEE MISSION PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4088
Mailing Address - Country:US
Mailing Address - Phone:913-544-9285
Mailing Address - Fax:913-229-7511
Practice Address - Street 1:6811 SHAWNEE MISSION PKWY STE 310
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66202-4088
Practice Address - Country:US
Practice Address - Phone:913-544-9285
Practice Address - Fax:913-229-7511
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-18
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS#43421041C0700X
MO20140229691041C0700X
KS274842031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSUNKNOWNMedicaid