Provider Demographics
NPI:1083001044
Name:GOODMAN, VICKI (LMFT)
Entity Type:Individual
Prefix:
First Name:VICKI
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:537 BISCAYNE DR
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-8322
Mailing Address - Country:US
Mailing Address - Phone:415-302-9564
Mailing Address - Fax:
Practice Address - Street 1:537 BISCAYNE DR
Practice Address - Street 2:
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-8322
Practice Address - Country:US
Practice Address - Phone:415-302-9564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-16
Last Update Date:2015-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82028106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist