Provider Demographics
NPI:1760151302
Name:GOODWIN, MORLINE (LCSW)
Entity Type:Individual
Prefix:
First Name:MORLINE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1064 CARROLL PL
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-5706
Mailing Address - Country:US
Mailing Address - Phone:929-222-4647
Mailing Address - Fax:
Practice Address - Street 1:1064 CARROLL PL
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10456-5706
Practice Address - Country:US
Practice Address - Phone:929-222-4647
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2023-10-25
Deactivation Date:2023-03-24
Deactivation Code:
Reactivation Date:2023-04-20
Provider Licenses
StateLicense IDTaxonomies
NY090411-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical