Provider Demographics
NPI:1578923678
Name:GOODMAN, KATHERINE BREWER (LPC)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:BREWER
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:KATHERINE
Other - Middle Name:CHARLOTTE
Other - Last Name:BREWER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:345 BUCKLAND HILLS DR
Mailing Address - Street 2:APT 12222
Mailing Address - City:MANCHESTER
Mailing Address - State:CT
Mailing Address - Zip Code:06042-8704
Mailing Address - Country:US
Mailing Address - Phone:203-247-3996
Mailing Address - Fax:
Practice Address - Street 1:345 BUCKLAND HILLS DR
Practice Address - Street 2:APT 12222
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06042-8704
Practice Address - Country:US
Practice Address - Phone:203-247-3996
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-02
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002807101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional