Provider Demographics
NPI:1235476490
Name:JEFFREY S GOODMAN PHD, PC
Entity Type:Organization
Organization Name:JEFFREY S GOODMAN PHD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:SAMUEL
Authorized Official - Last Name:GOODMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:757-397-4394
Mailing Address - Street 1:355 CRAWFORD ST
Mailing Address - Street 2:SUITE 804
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23704-2816
Mailing Address - Country:US
Mailing Address - Phone:757-397-4394
Mailing Address - Fax:757-393-3990
Practice Address - Street 1:355 CRAWFORD ST
Practice Address - Street 2:SUITE 804
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23704-2816
Practice Address - Country:US
Practice Address - Phone:757-397-4394
Practice Address - Fax:757-393-3990
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty