Provider Demographics
NPI:1336753748
Name:GOIN, REBECCA JO (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:REBECCA
Middle Name:JO
Last Name:GOIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8400 FAMOUS CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40219-3944
Mailing Address - Country:US
Mailing Address - Phone:502-432-5145
Mailing Address - Fax:
Practice Address - Street 1:13700 ENGLISH VILLA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40245-3938
Practice Address - Country:US
Practice Address - Phone:502-254-2361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-02
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY32341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical