Provider Demographics
NPI:1639898430
Name:GOODEN, AMBER DANIELLE
Entity Type:Individual
Prefix:MISS
First Name:AMBER
Middle Name:DANIELLE
Last Name:GOODEN
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 1:15408 BREWSTER RD
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-3506
Mailing Address - Country:US
Mailing Address - Phone:267-259-6432
Mailing Address - Fax:
Practice Address - Street 1:15408 BREWSTER RD
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-3506
Practice Address - Country:US
Practice Address - Phone:267-259-6432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-08-24
Last Update Date:2022-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor