| Doctor Name: | EDWIN BAKER GOODALL |
| NPI Number: | 1134348329 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH.D. |
| License Number: | 196 |
| Business Practice Address: | 401 Gilford Ave Unit 103 Gilford, NH - 032497500 |
| Business Phone Number: | 6034967955 |
| Business Fax Number: | 6035282257 |
| Mailing Address: | Po Box 134, CENTER SANDWICH |
| State: | NH |
| Postal Code: | 032270134 |
| Phone Number: | 6032847174 |
| Fax Number: | 6035282257 |
| NPI Enumeration Date: | 04/25/2007 |
| NPI Last Update Date: | 07/09/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | 196 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NH |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |