Provider Demographics
NPI:1003107632
Name:GOODMAN, ADRIENNE JOELLE (DACM, LAC)
Entity Type:Individual
Prefix:DR
First Name:ADRIENNE
Middle Name:JOELLE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:DACM, LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:669 ROUTE 31
Mailing Address - Street 2:
Mailing Address - City:MACEDON
Mailing Address - State:NY
Mailing Address - Zip Code:14502-9107
Mailing Address - Country:US
Mailing Address - Phone:315-310-5538
Mailing Address - Fax:
Practice Address - Street 1:669 ROUTE 31
Practice Address - Street 2:
Practice Address - City:MACEDON
Practice Address - State:NY
Practice Address - Zip Code:14502-9107
Practice Address - Country:US
Practice Address - Phone:315-310-5538
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2022-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004574171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist