Provider Demographics
NPI:1881726321
Name:GOUDIE, MARIA TERESA (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARIA
Middle Name:TERESA
Last Name:GOUDIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:M.
Other - Middle Name:TERESA
Other - Last Name:GOUDIE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:484 W 43RD ST
Mailing Address - Street 2:43-D
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10036-6319
Mailing Address - Country:US
Mailing Address - Phone:212-868-2735
Mailing Address - Fax:
Practice Address - Street 1:240 W END AVE
Practice Address - Street 2:GAINES (1-A)
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3613
Practice Address - Country:US
Practice Address - Phone:212-868-2735
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR020939-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical