Provider Demographics
NPI:1891745063
Name:GODDESS, LINNEA (LCSW)
Entity Type:Individual
Prefix:
First Name:LINNEA
Middle Name:
Last Name:GODDESS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1417 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19806-1316
Mailing Address - Country:US
Mailing Address - Phone:302-743-3218
Mailing Address - Fax:302-655-4027
Practice Address - Street 1:1400 PEOPLES PLZ
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19702-5707
Practice Address - Country:US
Practice Address - Phone:302-743-3218
Practice Address - Fax:302-655-4027
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ1-00002531041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical