Provider Demographics
NPI:1659158269
Name:GOODMAN, ALEXANDER M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ALEXANDER
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 RIVERSIDE AVE APT 2G
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1046
Mailing Address - Country:US
Mailing Address - Phone:917-640-5260
Mailing Address - Fax:
Practice Address - Street 1:352 7TH AVE RM 306
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5075
Practice Address - Country:US
Practice Address - Phone:212-337-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-09-08
Last Update Date:2023-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY120735-011041C0700X
1041C0700X
NJ44SC062666001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical