Provider Demographics
NPI:1609927029
Name:GOODMAN, JUDY B (LMFT)
Entity Type:Individual
Prefix:MS
First Name:JUDY
Middle Name:B
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9550 WARNER AVE
Mailing Address - Street 2:#227
Mailing Address - City:FOUNTAIN VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92708-2800
Mailing Address - Country:US
Mailing Address - Phone:949-760-7551
Mailing Address - Fax:714-536-9897
Practice Address - Street 1:9550 WARNER AVE
Practice Address - Street 2:#227
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-2800
Practice Address - Country:US
Practice Address - Phone:949-760-7551
Practice Address - Fax:714-536-9897
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC31104106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist