Provider Demographics
NPI:1578572111
Name:GOODMAN, EVELYN M (PSYD LMFT)
Entity Type:Individual
Prefix:DR
First Name:EVELYN
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PSYD LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12313 HAVELOCK AVE
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230
Mailing Address - Country:US
Mailing Address - Phone:310-391-3853
Mailing Address - Fax:310-398-1156
Practice Address - Street 1:12313 HAVELOCK AVE
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230
Practice Address - Country:US
Practice Address - Phone:310-391-3853
Practice Address - Fax:310-398-1156
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18338106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist