| Kimberly Goodwin Lcsw-s Pllc | |
|
12119 Cherry Blossom St San Antonio TX 78247-4311 | |
| (210) 857-3096 | |
| Not Available |
| Full Name | Kimberly Goodwin Lcsw-s Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 12119 Cherry Blossom St, San Antonio, Texas |
| Authorized Official Name and Position | Kimberly Sandra-lynn Goodwin (OWNER) |
| Authorized Official Contact | 2108573096 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Kimberly Goodwin Lcsw-s Pllc 12119 Cherry Blossom St San Antonio TX 78247-4311 Ph: (210) 857-3096 | Kimberly Goodwin Lcsw-s Pllc 12119 Cherry Blossom St San Antonio TX 78247-4311 Ph: (210) 857-3096 |
| NPI Number | 1093309429 |
|---|---|
| Provider Enumeration Date | 02/25/2021 |
| Last Update Date | 02/25/2021 |
| Certification Date | 02/25/2021 |
| Medicare PECOS PAC ID | 8527477892 |
|---|---|
| Medicare Enrollment ID | O20210518000601 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1093309429 | NPI | - | NPPES |
| 378227803 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Kimberly S Goodwin |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1841703899 PECOS PAC ID: 5698032514 Enrollment ID: I20171201000947 |
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