Provider Demographics
NPI:1740484781
Name:GOODENOUGH, DIANNE C (MSW)
Entity type:Individual
Prefix:MISS
First Name:DIANNE
Middle Name:C
Last Name:GOODENOUGH
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 WAYMAN LN
Mailing Address - Street 2:P.O. BOX 8
Mailing Address - City:BAR HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04609-1625
Mailing Address - Country:US
Mailing Address - Phone:207-288-5082
Mailing Address - Fax:207-288-7024
Practice Address - Street 1:1 HANCOCK ST
Practice Address - Street 2:
Practice Address - City:BAR HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04609-1714
Practice Address - Country:US
Practice Address - Phone:207-288-5082
Practice Address - Fax:207-288-7024
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC6486101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MELC6486OtherMAINE LICENSE
MEMM8821Medicare ID - Type Unspecified