Provider Demographics
NPI:1689945610
Name:GOAD, ERIN (LISW)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:
Last Name:GOAD
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SULLIVAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LISW
Mailing Address - Street 1:450 SOUTHERN BLVD SE
Mailing Address - Street 2:
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-3206
Mailing Address - Country:US
Mailing Address - Phone:505-994-3305
Mailing Address - Fax:505-994-3316
Practice Address - Street 1:450 SOUTHERN BLVD SE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-3206
Practice Address - Country:US
Practice Address - Phone:505-994-3305
Practice Address - Fax:505-994-3316
Is Sole Proprietor?:No
Enumeration Date:2012-01-23
Last Update Date:2014-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-07441104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker