Provider Demographics
NPI:1336773415
Name:GOODWIN, LUKE (LMSW)
Entity Type:Individual
Prefix:
First Name:LUKE
Middle Name:
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S 3RD ST APT 12A
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4644
Mailing Address - Country:US
Mailing Address - Phone:804-356-0105
Mailing Address - Fax:
Practice Address - Street 1:7 W 36TH ST FL 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7151
Practice Address - Country:US
Practice Address - Phone:212-203-9792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-27
Last Update Date:2020-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1068441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical