Provider Demographics
NPI:1770506396
Name:GOODWIN, LORI ANN (BA)
Entity Type:Individual
Prefix:MRS
First Name:LORI
Middle Name:ANN
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3270 SUNTREE BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32940-7530
Mailing Address - Country:US
Mailing Address - Phone:321-752-3170
Mailing Address - Fax:321-752-3179
Practice Address - Street 1:3270 SUNTREE BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32940-7530
Practice Address - Country:US
Practice Address - Phone:321-752-3170
Practice Address - Fax:321-752-3179
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker