Individual
EDWIN BAKER GOODALL III
Active
Individual
EDWIN BAKER GOODALL III
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PH.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
196
NH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0602256YONHO1
ANTHEM BCBS
NH
05
—
80622256
—
NH
Enumeration date
04/25/2007
Last updated
07/09/2007
Update your record
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