Provider Demographics
NPI:1437895612
Name:GOODMAN, ALYSSA (LMSW/LGSW)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMSW/LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 SOUTHFIELD PL
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-3816
Mailing Address - Country:US
Mailing Address - Phone:301-458-0501
Mailing Address - Fax:
Practice Address - Street 1:9 SOUTHFIELD PL
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-3816
Practice Address - Country:US
Practice Address - Phone:301-458-0501
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-10
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLG500831701041C0700X
MD250271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical