Provider Demographics
NPI:1609504612
Name:GODWIN, PETER LAWRENCE (LMSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:LAWRENCE
Last Name:GODWIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:243 S MARKET ST APT 2
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21701-6526
Mailing Address - Country:US
Mailing Address - Phone:828-695-7134
Mailing Address - Fax:
Practice Address - Street 1:12073 TECH RD STE B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-7874
Practice Address - Country:US
Practice Address - Phone:301-593-1315
Practice Address - Fax:301-681-4699
Is Sole Proprietor?:No
Enumeration Date:2022-08-09
Last Update Date:2022-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD27658104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker