N/a | |
2230 Carter Ave Ste 9 Saint Paul MN 55108-1654 | |
(612) 564-3414 | |
Not Available |
Full Name | N/a |
---|---|
Speciality | Social Worker |
Location | 2230 Carter Ave Ste 9, Saint Paul, Minnesota |
Authorized Official Name and Position | Joshua Goodwin (OWNER/PSYCHOTHERAPIST) |
Authorized Official Contact | 6512459901 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
N/a 2230 Carter Ave Ste 9 Saint Paul MN 55108-1654 Ph: (651) 245-9901 | N/a 2230 Carter Ave Ste 9 Saint Paul MN 55108-1654 Ph: (612) 564-3414 |
NPI Number | 1871228734 |
---|---|
Provider Enumeration Date | 07/23/2022 |
Last Update Date | 03/25/2024 |
Certification Date | 08/17/2022 |
Medicare PECOS PAC ID | 7012384464 |
---|---|
Medicare Enrollment ID | O20221027003041 |
Identifier | Type | State | Issuer |
---|---|---|---|
1871228734 | NPI | - | NPPES |
H400899380 | Medicaid | MN |
Provider Name | Joshua Hampton Goodwin |
---|---|
Provider Type | Practitioner - Clinical Social Worker |
Provider Identifiers | NPI Number: 1730733098 PECOS PAC ID: 6507196201 Enrollment ID: I20190923003261 |
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