Provider Demographics
NPI:1497737944
Name:GOODMAN, KAREN JOYCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:JOYCE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KAREN
Other - Middle Name:GOODMAN
Other - Last Name:PERL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:39 COLLEGEVIEW AVENUE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-7203
Mailing Address - Country:US
Mailing Address - Phone:845-473-8300
Mailing Address - Fax:845-454-6014
Practice Address - Street 1:39 COLLEGEVIEW AVENUE
Practice Address - Street 2:
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-7203
Practice Address - Country:US
Practice Address - Phone:845-473-8300
Practice Address - Fax:845-454-6014
Is Sole Proprietor?:No
Enumeration Date:2005-11-18
Last Update Date:2007-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY00671701103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01661063Medicaid
NY01661063Medicaid