Provider Demographics
NPI:1275721300
Name:GOODMAN, DANIEL JOSEPH (PHD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:JOSEPH
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E SCHILLER ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:ELMHURST
Mailing Address - State:IL
Mailing Address - Zip Code:60126-2858
Mailing Address - Country:US
Mailing Address - Phone:630-279-5090
Mailing Address - Fax:630-279-5090
Practice Address - Street 1:110 E SCHILLER ST
Practice Address - Street 2:SUITE 212
Practice Address - City:ELMHURST
Practice Address - State:IL
Practice Address - Zip Code:60126-2858
Practice Address - Country:US
Practice Address - Phone:630-279-5090
Practice Address - Fax:630-279-5090
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-15
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071-007342103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical