Provider Demographics
NPI:1841452034
Name:GOODWIN, ELIZABETH A (PSYD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:A
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:585 GROVE ST. STE. 145 #736
Mailing Address - Street 2:
Mailing Address - City:HERNDON
Mailing Address - State:VA
Mailing Address - Zip Code:20170-4791
Mailing Address - Country:US
Mailing Address - Phone:202-855-7936
Mailing Address - Fax:954-408-0246
Practice Address - Street 1:585 GROVE ST. STE. 145 #736
Practice Address - Street 2:
Practice Address - City:HERNDON
Practice Address - State:VA
Practice Address - Zip Code:20170-4791
Practice Address - Country:US
Practice Address - Phone:202-855-7936
Practice Address - Fax:954-408-0246
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-27
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY12128103TC0700X
NY016821103TC0700X
CAPSY22852103TC0700X
VA0810005044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical