Provider Demographics
NPI:1790122422
Name:GOODWIN, ELIZABETH A (PCC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3659 GREEN RD
Mailing Address - Street 2:STE. 100
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-5727
Mailing Address - Country:US
Mailing Address - Phone:216-390-4944
Mailing Address - Fax:
Practice Address - Street 1:3659 S. GREEN RD
Practice Address - Street 2:100
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122
Practice Address - Country:US
Practice Address - Phone:216-390-4944
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE 1000076101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHE 1000076OtherCSWMFT