Provider Demographics
NPI:1013017672
Name:GOODMAN, MICHAELE E (PH D)
Entity Type:Individual
Prefix:
First Name:MICHAELE
Middle Name:E
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 PERRY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT CHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:10573-2920
Mailing Address - Country:US
Mailing Address - Phone:914-939-3414
Mailing Address - Fax:
Practice Address - Street 1:220 E 54TH ST
Practice Address - Street 2:SUITE #1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10022-4837
Practice Address - Country:US
Practice Address - Phone:212-593-5740
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY009860103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical