Provider Demographics
NPI:1942744602
Name:GOFF, SUSAN (LSW)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:GOFF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 WALKER AVE S
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44905-3044
Mailing Address - Country:US
Mailing Address - Phone:419-512-9718
Mailing Address - Fax:567-566-0448
Practice Address - Street 1:222 MARION AVE
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:OH
Practice Address - Zip Code:44903-2138
Practice Address - Country:US
Practice Address - Phone:567-560-3582
Practice Address - Fax:567-560-4484
Is Sole Proprietor?:No
Enumeration Date:2016-12-14
Last Update Date:2016-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1601081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker