Provider Demographics
NPI:1861615593
Name:GOODIE, ELIZABETH T (LCSW)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:T
Last Name:GOODIE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:73 REED ST
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3622
Mailing Address - Country:US
Mailing Address - Phone:207-797-0032
Mailing Address - Fax:
Practice Address - Street 1:73 REED ST
Practice Address - Street 2:
Practice Address - City:WESTBROOK
Practice Address - State:ME
Practice Address - Zip Code:04092-3622
Practice Address - Country:US
Practice Address - Phone:207-797-0032
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2016-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC43791041C0700X
MELC 4379101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MEMM5657Medicare PIN
MEE400169899Medicare PIN
MEMM565701Medicare PIN