Provider Demographics
NPI:1629264452
Name:GOOD, JEANETTE ANDERSON (LPC PHD)
Entity Type:Individual
Prefix:DR
First Name:JEANETTE
Middle Name:ANDERSON
Last Name:GOOD
Suffix:
Gender:F
Credentials:LPC PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:146 W GRAND AVENUE
Mailing Address - Street 2:OCEAN PARK MEADOWS #24
Mailing Address - City:OLD ORCHARD BEACH
Mailing Address - State:ME
Mailing Address - Zip Code:04064
Mailing Address - Country:US
Mailing Address - Phone:207-934-9882
Mailing Address - Fax:
Practice Address - Street 1:884 BROADWAY
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-767-1165
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2007-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELP 2072101YP1600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral