Provider Demographics
NPI:1922278936
Name:GOODWILL, DONNA M (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:M
Last Name:GOODWILL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 DEER RUN RD
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:MA
Mailing Address - Zip Code:01460-1320
Mailing Address - Country:US
Mailing Address - Phone:978-790-6578
Mailing Address - Fax:
Practice Address - Street 1:271 GREAT RD STE 25
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4772
Practice Address - Country:US
Practice Address - Phone:978-790-6578
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10266381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical