Provider Demographics
NPI:1952454415
Name:GOODING, LORI J (MSW, MSOM)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:J
Last Name:GOODING
Suffix:
Gender:F
Credentials:MSW, MSOM
Other - Prefix:
Other - First Name:LORI
Other - Middle Name:J
Other - Last Name:WOODFORK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 533
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-0533
Mailing Address - Country:US
Mailing Address - Phone:315-405-2323
Mailing Address - Fax:
Practice Address - Street 1:117 SHERMAN ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-3209
Practice Address - Country:US
Practice Address - Phone:315-405-2323
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2020-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003378-1171100000X
NYR055161-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical