Provider Demographics
NPI:1336211861
Name:GOODNOW, ETHEL ANN (MSW)
Entity Type:Individual
Prefix:MS
First Name:ETHEL
Middle Name:ANN
Last Name:GOODNOW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:MS
Other - First Name:JUDY EA
Other - Middle Name:
Other - Last Name:GOODNOW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:2418 MILES RD SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106
Mailing Address - Country:US
Mailing Address - Phone:505-243-2923
Mailing Address - Fax:505-842-5103
Practice Address - Street 1:2418 MILES RD SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106
Practice Address - Country:US
Practice Address - Phone:505-243-2923
Practice Address - Fax:505-842-1503
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI19211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMI1921OtherSTATE LICENSE NUMBER
NMI1921OtherSTATE LICENSE NUMBER