Provider Demographics
NPI:1649434507
Name:GOODE, COLLEEN M (MED, LMHC)
Entity type:Individual
Prefix:PROF
First Name:COLLEEN
Middle Name:M
Last Name:GOODE
Suffix:
Gender:F
Credentials:MED, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38 MONTVALE AVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-2446
Mailing Address - Country:US
Mailing Address - Phone:781-910-4455
Mailing Address - Fax:
Practice Address - Street 1:38 MONTVALE AVE
Practice Address - Street 2:SUITE #207
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180-2446
Practice Address - Country:US
Practice Address - Phone:781-910-4455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-10
Last Update Date:2008-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6106101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health