Provider Demographics
NPI:1902817208
Name:GOODNOW, LEAH MARIE (LCSW)
Entity Type:Individual
Prefix:
First Name:LEAH
Middle Name:MARIE
Last Name:GOODNOW
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 1:920 EAST BALTIMORE PIKE SUITE 200
Mailing Address - Street 2:HOLCOMB BHS
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348
Mailing Address - Country:US
Mailing Address - Phone:610-388-9225
Mailing Address - Fax:610-388-3224
Practice Address - Street 1:920 EAST BATIMORE PIKE SUITE 200
Practice Address - Street 2:HOLCOMB BHS
Practice Address - City:KENNETT SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19348
Practice Address - Country:US
Practice Address - Phone:610-388-9225
Practice Address - Fax:610-388-3224
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW124994104100000X
PACW0158341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker