Provider Demographics
NPI:1033543343
Name:GOODMAN, ERAKAL (CBHCMS)
Entity Type:Individual
Prefix:
First Name:ERAKAL
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:CBHCMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7035 PHILIPS HWY STE 11
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-6071
Mailing Address - Country:US
Mailing Address - Phone:386-283-2010
Mailing Address - Fax:
Practice Address - Street 1:623 BEECHWOOD ST
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32206-6236
Practice Address - Country:US
Practice Address - Phone:904-358-1211
Practice Address - Fax:904-358-1551
Is Sole Proprietor?:No
Enumeration Date:2013-08-23
Last Update Date:2020-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health