Provider Demographics
NPI:1902175169
Name:GOODMAN, LOUISE A (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:LOUISE
Middle Name:A
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:LOUISE
Other - Middle Name:
Other - Last Name:ASHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17 LONGFELLOW RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-1714
Mailing Address - Country:US
Mailing Address - Phone:339-234-3171
Mailing Address - Fax:
Practice Address - Street 1:76 BEDFORD ST
Practice Address - Street 2:SUITE 21
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4646
Practice Address - Country:US
Practice Address - Phone:339-234-3171
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-17
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1162691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical