Provider Demographics
NPI:1578879672
Name:GOODMAN, MELINDA B (PHD)
Entity Type:Individual
Prefix:MS
First Name:MELINDA
Middle Name:B
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 KEY HWY
Mailing Address - Street 2:STE 300M
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21230-5142
Mailing Address - Country:US
Mailing Address - Phone:352-359-3227
Mailing Address - Fax:
Practice Address - Street 1:1414 KEY HWY
Practice Address - Street 2:STE 300M
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230-5142
Practice Address - Country:US
Practice Address - Phone:352-359-3227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016706103T00000X
MD4822103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist