Provider Demographics
NPI:1215028113
Name:GOOD, NANCY
Entity Type:Individual
Prefix:MS
First Name:NANCY
Middle Name:
Last Name:GOOD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NANCY
Other - Middle Name:
Other - Last Name:GOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:210 W 101ST ST
Mailing Address - Street 2:APT 16L
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-5065
Mailing Address - Country:US
Mailing Address - Phone:212-865-9014
Mailing Address - Fax:212-865-9461
Practice Address - Street 1:865 W END AVE
Practice Address - Street 2:APT 1C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-8402
Practice Address - Country:US
Practice Address - Phone:212-865-9014
Practice Address - Fax:212-865-9461
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0179761041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N27481Medicare UPIN
NYN27481Medicare ID - Type Unspecified