Provider Demographics
NPI:1932440872
Name:GOODWIN, LYNNE M (LMFT)
Entity Type:Individual
Prefix:
First Name:LYNNE
Middle Name:M
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06111-4307
Mailing Address - Country:US
Mailing Address - Phone:860-667-1338
Mailing Address - Fax:
Practice Address - Street 1:111 HOWARD ST
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:CT
Practice Address - Zip Code:06111-4307
Practice Address - Country:US
Practice Address - Phone:860-667-1338
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-01
Last Update Date:2013-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000777106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist