Provider Demographics
NPI:1043559545
Name:GOODRICH, ERIC
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-1932
Mailing Address - Country:US
Mailing Address - Phone:716-852-1117
Mailing Address - Fax:716-852-1110
Practice Address - Street 1:254 FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-1932
Practice Address - Country:US
Practice Address - Phone:716-852-1117
Practice Address - Fax:716-852-1110
Is Sole Proprietor?:No
Enumeration Date:2013-02-05
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080586104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker