Provider Demographics
NPI:1114267952
Name:GOODMAN, NANCY R (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:R
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6917 ARLINGTON RD STE 220
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-5212
Mailing Address - Country:US
Mailing Address - Phone:301-951-3440
Mailing Address - Fax:
Practice Address - Street 1:6917 ARLINGTON RD STE 220
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-5212
Practice Address - Country:US
Practice Address - Phone:301-951-3440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-14
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01510103TC0700X, 103TP0814X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0814XBehavioral Health & Social Service ProvidersPsychologistPsychoanalysis
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical