Provider Demographics
NPI:1497961445
Name:GOODRICH, LOIS EVELYN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOIS
Middle Name:EVELYN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 CHANDLER ST
Mailing Address - Street 2:
Mailing Address - City:HOULTON
Mailing Address - State:ME
Mailing Address - Zip Code:04730-1669
Mailing Address - Country:US
Mailing Address - Phone:207-532-6073
Mailing Address - Fax:
Practice Address - Street 1:2 WATER ST
Practice Address - Street 2:
Practice Address - City:HOULTON
Practice Address - State:ME
Practice Address - Zip Code:04730-2126
Practice Address - Country:US
Practice Address - Phone:207-532-5510
Practice Address - Fax:207-532-5518
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC28391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical