Provider Demographics
NPI:1285865295
Name:GOODMAN, MIRIAM R (LMSW)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:R
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 1ST ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-2605
Mailing Address - Country:US
Mailing Address - Phone:917-846-0274
Mailing Address - Fax:
Practice Address - Street 1:180 LIVINGSTON ST STE 303
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-5861
Practice Address - Country:US
Practice Address - Phone:347-328-8110
Practice Address - Fax:347-328-8117
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-07
Last Update Date:2009-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0795021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical