1588664163 NPI number — MR. DAVID ARTHUR GOOLSBY LCSW

Table of content: MR. DAVID ARTHUR GOOLSBY LCSW (NPI 1588664163)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588664163 NPI number — MR. DAVID ARTHUR GOOLSBY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GOOLSBY
Provider First Name:
DAVID
Provider Middle Name:
ARTHUR
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MORGAN-GOOLSBY
Provider Other First Name:
DAVID
Provider Other Middle Name:
ARTHUR
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW-CC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1588664163
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/13/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 700
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LINCOLN
Provider Business Mailing Address State Name:
ME
Provider Business Mailing Address Postal Code:
04457
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
207-794-8990
Provider Business Mailing Address Fax Number:
207-403-9093

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26B ENFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LINCOLN
Provider Business Practice Location Address State Name:
ME
Provider Business Practice Location Address Postal Code:
04457-1190
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
207-794-8990
Provider Business Practice Location Address Fax Number:
207-403-9093
Provider Enumeration Date:
07/26/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LC6715 , registered in the state of ME ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 431819099 , issued by the state of ( ME ) . This identifiers is of the category "MEDICAID".




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