Provider Demographics
NPI:1497725428
Name:GOODWIN, BRICE ANTHONY (PHD)
Entity Type:Individual
Prefix:DR
First Name:BRICE
Middle Name:ANTHONY
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PSC 451 BOX 340
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AE
Mailing Address - Zip Code:09834
Mailing Address - Country:BH
Mailing Address - Phone:0119731-785-4857
Mailing Address - Fax:
Practice Address - Street 1:PSC 451 BOX 340
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09834
Practice Address - Country:BH
Practice Address - Phone:0119731-785-4857
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-24
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0638103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical