Provider Demographics
NPI:1326190315
Name:GOODMAN, ABBE ARLENE (MA)
Entity Type:Individual
Prefix:MRS
First Name:ABBE
Middle Name:ARLENE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 W OLIVE AVE
Mailing Address - Street 2:SUITE 500
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4549
Mailing Address - Country:US
Mailing Address - Phone:818-766-5663
Mailing Address - Fax:818-766-5669
Practice Address - Street 1:2600 W OLIVE AVE
Practice Address - Street 2:SUITE 500
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4549
Practice Address - Country:US
Practice Address - Phone:818-766-5663
Practice Address - Fax:818-766-5669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18873106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALMFTMFC18873OtherBOARD OF BEHAVIORAL SCIEN