Provider Demographics
NPI:1659512515
Name:GOODMAN, ELISABETH ANNE (PHD, NCSP, SP560)
Entity Type:Individual
Prefix:DR
First Name:ELISABETH
Middle Name:ANNE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD, NCSP, SP560
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25221 MILES RD
Mailing Address - Street 2:SUITE F
Mailing Address - City:WARRENSVILLE HEIGHTS
Mailing Address - State:OH
Mailing Address - Zip Code:44128-5474
Mailing Address - Country:US
Mailing Address - Phone:216-586-2319
Mailing Address - Fax:216-292-1391
Practice Address - Street 1:25221 MILES RD
Practice Address - Street 2:SUITE F
Practice Address - City:WARRENSVILLE HEIGHTS
Practice Address - State:OH
Practice Address - Zip Code:44128-5474
Practice Address - Country:US
Practice Address - Phone:216-586-2319
Practice Address - Fax:216-292-1391
Is Sole Proprietor?:No
Enumeration Date:2009-03-23
Last Update Date:2009-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHSP 560103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool