Provider Demographics
NPI:1730733098
Name:GOODWIN, JOSHUA HAMPTON (MSW, LICSW)
Entity type:Individual
Prefix:
First Name:JOSHUA
Middle Name:HAMPTON
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 CARTER AVE STE 9
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-1654
Mailing Address - Country:US
Mailing Address - Phone:612-564-3414
Mailing Address - Fax:
Practice Address - Street 1:2230 CARTER AVE STE 9
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-1654
Practice Address - Country:US
Practice Address - Phone:612-564-3414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2022-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN256591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical