Provider Demographics
NPI:1346567534
Name:MICHELLE A. GOODNOW LLC
Entity Type:Organization
Organization Name:MICHELLE A. GOODNOW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:MS
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOODNOW
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:508-393-9800
Mailing Address - Street 1:52 MAYFAIR DR
Mailing Address - Street 2:
Mailing Address - City:BOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01719-1838
Mailing Address - Country:US
Mailing Address - Phone:978-266-0187
Mailing Address - Fax:
Practice Address - Street 1:96 W MAIN ST
Practice Address - Street 2:SUITE 3
Practice Address - City:NORTHBOROUGH
Practice Address - State:MA
Practice Address - Zip Code:01532-3810
Practice Address - Country:US
Practice Address - Phone:508-393-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-27
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty