Provider Demographics
NPI:1639887367
Name:GOODMAN, LUCY ROSE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LUCY
Middle Name:ROSE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-2402
Mailing Address - Country:US
Mailing Address - Phone:610-256-0180
Mailing Address - Fax:
Practice Address - Street 1:928 JAYMOR RD STE B-150
Practice Address - Street 2:
Practice Address - City:SOUTHAMPTON
Practice Address - State:PA
Practice Address - Zip Code:18966-3853
Practice Address - Country:US
Practice Address - Phone:215-947-8654
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-11
Last Update Date:2022-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS019757103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty