Provider Demographics
NPI:1467541961
Name:GOODMAN, JANE GOZ (MSW BCD)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:GOZ
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MSW BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1052 S MCKNIGHT RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1010
Mailing Address - Country:US
Mailing Address - Phone:314-991-4961
Mailing Address - Fax:
Practice Address - Street 1:1052 S MCKNIGHT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63117-1010
Practice Address - Country:US
Practice Address - Phone:314-991-4961
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO000030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist