Provider Demographics
NPI:1407195217
Name:GOEBEL, JUSTINE K (MSW)
Entity Type:Individual
Prefix:MS
First Name:JUSTINE
Middle Name:K
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JUSTINE
Other - Middle Name:A
Other - Last Name:KNOWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:1850 OLYMPIAN WAY
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33881-2161
Mailing Address - Country:US
Mailing Address - Phone:863-595-0167
Mailing Address - Fax:866-611-6538
Practice Address - Street 1:1850 OLYMPIAN WAY
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881-2161
Practice Address - Country:US
Practice Address - Phone:863-595-0167
Practice Address - Fax:866-611-6538
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker