Provider Demographics
NPI:1790805471
Name:GOODWIN, CYNTHIA RAE (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:RAE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CYNDI
Other - Middle Name:R
Other - Last Name:GOODWIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:2140B CRAWFORDVILLE HWY
Mailing Address - Street 2:
Mailing Address - City:CRAWFORDVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32327-1009
Mailing Address - Country:US
Mailing Address - Phone:850-926-1900
Mailing Address - Fax:850-926-1930
Practice Address - Street 1:2140B CRAWFORDVILLE HWY
Practice Address - Street 2:
Practice Address - City:CRAWFORDVILLE
Practice Address - State:FL
Practice Address - Zip Code:32327-1009
Practice Address - Country:US
Practice Address - Phone:850-926-1900
Practice Address - Fax:850-926-1930
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2023-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW63341041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL117202400Medicaid