Provider Demographics
NPI:1033217088
Name:GOODMAN, MATTHEW BOYAR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MATTHEW
Middle Name:BOYAR
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:NEW BEDFORD
Mailing Address - State:MA
Mailing Address - Zip Code:02740-5951
Mailing Address - Country:US
Mailing Address - Phone:508-993-2003
Mailing Address - Fax:508-993-2003
Practice Address - Street 1:106 SPRING ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5951
Practice Address - Country:US
Practice Address - Phone:508-993-2003
Practice Address - Fax:508-993-2003
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7210103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW50351Medicare PIN