Provider Demographics
NPI:1245317221
Name:GOLDKOPF-WOODTKE, MARGARET G (LCSW)
Entity type:Individual
Prefix:MRS
First Name:MARGARET
Middle Name:G
Last Name:GOLDKOPF-WOODTKE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:MARGARET
Other - Middle Name:M
Other - Last Name:GOLDKOPF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:543 NORTH MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06040
Mailing Address - Country:US
Mailing Address - Phone:860-645-9468
Mailing Address - Fax:860-649-6751
Practice Address - Street 1:543 NORTH MAIN ST
Practice Address - Street 2:
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-645-9468
Practice Address - Fax:860-649-6751
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0021381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004180288Medicaid