Provider Demographics
NPI:1811218571
Name:GOODWIN-MOORE, CARL LESLIE (LMSW-CC)
Entity Type:Individual
Prefix:
First Name:CARL
Middle Name:LESLIE
Last Name:GOODWIN-MOORE
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 570
Mailing Address - Street 2:
Mailing Address - City:LINCOLNVILLE
Mailing Address - State:ME
Mailing Address - Zip Code:04849-0570
Mailing Address - Country:US
Mailing Address - Phone:207-323-5143
Mailing Address - Fax:
Practice Address - Street 1:9 FIELD ST
Practice Address - Street 2:SUITE 434
Practice Address - City:BELFAST
Practice Address - State:ME
Practice Address - Zip Code:04915-6661
Practice Address - Country:US
Practice Address - Phone:207-338-8960
Practice Address - Fax:207-338-8962
Is Sole Proprietor?:No
Enumeration Date:2010-06-17
Last Update Date:2010-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC124091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical