Provider Demographics
NPI:1144413063
Name:GOODSPEED, LAURA MARGARET (MA, MFT (MFC#49741))
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:MARGARET
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:MA, MFT (MFC#49741)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 GOUGH ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-7622
Mailing Address - Country:US
Mailing Address - Phone:415-420-3298
Mailing Address - Fax:415-931-3773
Practice Address - Street 1:1010 GOUGH ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-7622
Practice Address - Country:US
Practice Address - Phone:415-420-3298
Practice Address - Fax:415-931-3773
Is Sole Proprietor?:No
Enumeration Date:2007-08-23
Last Update Date:2011-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
CAMFC49741106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical