Provider Demographics
NPI:1073088605
Name:GOOD, CHRISTINE R (PSYA (NJ STATE CERTI)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:R
Last Name:GOOD
Suffix:
Gender:F
Credentials:PSYA (NJ STATE CERTI
Other - Prefix:MRS
Other - First Name:CHRISTINE
Other - Middle Name:RAE
Other - Last Name:PENNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9 POST RD.
Mailing Address - Street 2:SUITE D-1
Mailing Address - City:OAKLAND
Mailing Address - State:NJ
Mailing Address - Zip Code:07436-9998
Mailing Address - Country:US
Mailing Address - Phone:201-394-6327
Mailing Address - Fax:
Practice Address - Street 1:9 POST RD.
Practice Address - Street 2:SUITE D-1
Practice Address - City:OAKLAND
Practice Address - State:NJ
Practice Address - Zip Code:07436-9998
Practice Address - Country:US
Practice Address - Phone:201-394-6327
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-10
Last Update Date:2021-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001047102L00000X
NJ48PA00001600102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst