Provider Demographics
NPI:1629132758
Name:GOODMAN, JANET M (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANET
Middle Name:M
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 1:25515 HALBURTON RD
Mailing Address - Street 2:
Mailing Address - City:BEACHWOOD
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4182
Mailing Address - Country:US
Mailing Address - Phone:216-464-6624
Mailing Address - Fax:216-378-8900
Practice Address - Street 1:23875 COMMERCE PARK RD
Practice Address - Street 2:SUITE 160
Practice Address - City:BEACHWOOD
Practice Address - State:OH
Practice Address - Zip Code:44122-4182
Practice Address - Country:US
Practice Address - Phone:216-595-1455
Practice Address - Fax:216-378-8900
Is Sole Proprietor?:No
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE1938101YP2500X
OH6099103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHGOCP30791Medicare ID - Type Unspecified
Q35765Medicare UPIN