Provider Demographics
NPI:1598338527
Name:GOODMAN, RACHEL SHIRA
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SHIRA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:338 E GARFIELD ST
Mailing Address - Street 2:
Mailing Address - City:TEMPE
Mailing Address - State:AZ
Mailing Address - Zip Code:85281-1015
Mailing Address - Country:US
Mailing Address - Phone:602-377-4811
Mailing Address - Fax:
Practice Address - Street 1:1776 N SCOTTSDALE RD # 10462
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85257-2115
Practice Address - Country:US
Practice Address - Phone:602-341-8678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist