Provider Demographics
NPI:1508108895
Name:GOODMAN, MICHELLE D (BS,CADC,CCS,WTS)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:D
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:BS,CADC,CCS,WTS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3007 KEARSARGE RD
Mailing Address - Street 2:
Mailing Address - City:CAMDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08104
Mailing Address - Country:US
Mailing Address - Phone:609-504-9035
Mailing Address - Fax:856-203-3825
Practice Address - Street 1:3007 KEARSARGE RD
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:NJ
Practice Address - Zip Code:08104
Practice Address - Country:US
Practice Address - Phone:609-504-9035
Practice Address - Fax:856-203-3825
Is Sole Proprietor?:No
Enumeration Date:2013-03-25
Last Update Date:2013-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC0046700101YA0400X
NJ37CA00052300101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)