Provider Demographics
NPI:1891115689
Name:KATE GOODELL
Entity Type:Organization
Organization Name:KATE GOODELL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:KATE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOODELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-540-9112
Mailing Address - Street 1:4810 CROWSON AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-4409
Mailing Address - Country:US
Mailing Address - Phone:443-540-9112
Mailing Address - Fax:
Practice Address - Street 1:4810 CROWSON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4409
Practice Address - Country:US
Practice Address - Phone:443-540-9112
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-21
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD156311041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty