Provider Demographics
NPI:1003983396
Name:GOODE, DANA F (PSY D)
Entity Type:Individual
Prefix:DR
First Name:DANA
Middle Name:F
Last Name:GOODE
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 WALNUT STREET
Mailing Address - Street 2:SUITE 1700
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19107
Mailing Address - Country:US
Mailing Address - Phone:215-925-5456
Mailing Address - Fax:215-545-8496
Practice Address - Street 1:1315 WALNUT STREET
Practice Address - Street 2:SUITE 1700
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19107
Practice Address - Country:US
Practice Address - Phone:215-925-5456
Practice Address - Fax:215-545-8496
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006644L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0686465000OtherPERSONAL CHOICE
7323085OtherAETNA
7323085OtherAETNA