Provider Demographics
NPI:1568822526
Name:GOODMAN, JANAY (PLMSW)
Entity Type:Individual
Prefix:
First Name:JANAY
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12004 ZIA RD NE APT C3
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-1447
Mailing Address - Country:US
Mailing Address - Phone:505-401-4811
Mailing Address - Fax:
Practice Address - Street 1:3232 CANDELARIA RD NE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87107-1907
Practice Address - Country:US
Practice Address - Phone:505-323-3785
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician