Provider Demographics
NPI:1831218528
Name:GOODRICH, KIMBERLY DAWN (MSW, LCSW, LCADC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:GOODRICH
Suffix:
Gender:F
Credentials:MSW, LCSW, LCADC
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:DAWN
Other - Last Name:HEINZER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1901 DOOLITTLE DR
Mailing Address - Street 2:
Mailing Address - City:BRIDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:08807-7032
Mailing Address - Country:US
Mailing Address - Phone:908-334-0261
Mailing Address - Fax:
Practice Address - Street 1:12 LOWER CENTER ST STE 12
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:NJ
Practice Address - Zip Code:08809-1423
Practice Address - Country:US
Practice Address - Phone:732-455-1623
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-27
Last Update Date:2021-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00144300101YA0400X
NJ44SC053400001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)