Provider Demographics
NPI:1558569020
Name:GOODWIN, MARK DANIEL (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:DANIEL
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12601-1451
Mailing Address - Country:US
Mailing Address - Phone:917-693-8924
Mailing Address - Fax:
Practice Address - Street 1:1650 SELWYN AVE
Practice Address - Street 2:6D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-7626
Practice Address - Country:US
Practice Address - Phone:347-443-6521
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-06
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0752701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY126230OtherNYSDOH SCREEN ID