Provider Demographics
NPI:1265009450
Name:GOODMAN, CASSANDRA (EDS)
Entity Type:Individual
Prefix:
First Name:CASSANDRA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4338 E WOODRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032-9226
Mailing Address - Country:US
Mailing Address - Phone:928-266-8740
Mailing Address - Fax:
Practice Address - Street 1:2930 E NORTHERN AVE STE A105
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-4844
Practice Address - Country:US
Practice Address - Phone:602-428-2838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-07
Last Update Date:2021-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool