Provider Demographics
NPI:1689661548
Name:GOODMAN, LISA ELLEN (LPC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ELLEN
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:125 MAIN ST
Mailing Address - Street 2:#502
Mailing Address - City:BRADFORD
Mailing Address - State:PA
Mailing Address - Zip Code:16701-2025
Mailing Address - Country:US
Mailing Address - Phone:814-368-8644
Mailing Address - Fax:814-368-6216
Practice Address - Street 1:125 MAIN ST
Practice Address - Street 2:#601
Practice Address - City:BRADFORD
Practice Address - State:PA
Practice Address - Zip Code:16701-2025
Practice Address - Country:US
Practice Address - Phone:814-368-8644
Practice Address - Fax:814-368-6216
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2017-06-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAPC000862101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional