Provider Demographics
NPI:1902925159
Name:GOODWIN, ANTOINETTE IRENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANTOINETTE
Middle Name:IRENE
Last Name:GOODWIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:ONE CHANNEL DRIVE
Mailing Address - Street 2:UNIT 1713
Mailing Address - City:MONMOUTH BEACH
Mailing Address - State:NJ
Mailing Address - Zip Code:07750-1365
Mailing Address - Country:US
Mailing Address - Phone:732-229-6353
Mailing Address - Fax:
Practice Address - Street 1:100 OVERLOOK CTR
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540-7814
Practice Address - Country:US
Practice Address - Phone:609-375-2146
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00151400106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist