Provider Demographics
NPI:1205508835
Name:GOETZ, ABRAHAM ROBERT (LISW)
Entity type:Individual
Prefix:
First Name:ABRAHAM
Middle Name:ROBERT
Last Name:GOETZ
Suffix:
Gender:M
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3028 SW 39TH ST
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50321-1334
Mailing Address - Country:US
Mailing Address - Phone:515-207-5130
Mailing Address - Fax:
Practice Address - Street 1:1001 OFFICE PARK RD STE 115
Practice Address - Street 2:
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50265-2509
Practice Address - Country:US
Practice Address - Phone:515-207-5130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-01
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098266104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker