Provider Demographics
NPI:1073620092
Name:GOODMAN, NANCY J (LCSW)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:J
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 US HIGHWAY 46
Mailing Address - Street 2:
Mailing Address - City:HACKETTSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07840-2602
Mailing Address - Country:US
Mailing Address - Phone:908-852-9000
Mailing Address - Fax:
Practice Address - Street 1:26 US HIGHWAY 46
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2602
Practice Address - Country:US
Practice Address - Phone:908-852-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-24
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37FI00115800106H00000X
NJ44SC004437001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ641830S2FMedicare PIN