Provider Demographics
NPI:1760463236
Name:DR STANLEY AND PEARL GOODMAN JFS OF BROWARD COUNTY INC
Entity Type:Organization
Organization Name:DR STANLEY AND PEARL GOODMAN JFS OF BROWARD COUNTY INC
Other - Org Name:GOODMAN JFS OF BROWARD COUNTY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:COLEMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-370-2140
Mailing Address - Street 1:5890 S PINE ISLAND RD STE 201
Mailing Address - Street 2:
Mailing Address - City:DAVIE
Mailing Address - State:FL
Mailing Address - Zip Code:33328-5936
Mailing Address - Country:US
Mailing Address - Phone:954-370-2140
Mailing Address - Fax:954-916-1252
Practice Address - Street 1:5890 S PINE ISLAND RD STE 201
Practice Address - Street 2:
Practice Address - City:DAVIE
Practice Address - State:FL
Practice Address - Zip Code:33328-5936
Practice Address - Country:US
Practice Address - Phone:954-370-2140
Practice Address - Fax:954-916-1252
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-10
Last Update Date:2022-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL00792Medicare PIN