Provider Demographics
NPI:1659084580
Name:GOODMAN, IRENE LESLIE (MSW LMSW)
Entity Type:Individual
Prefix:MS
First Name:IRENE
Middle Name:LESLIE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSW LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 RIVER ST APT 209
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-5210
Mailing Address - Country:US
Mailing Address - Phone:919-265-3726
Mailing Address - Fax:
Practice Address - Street 1:411 RIVER ST APT 209
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29601-5210
Practice Address - Country:US
Practice Address - Phone:919-265-3726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-05
Last Update Date:2023-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC10900104100000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker