Provider Demographics
NPI:1790849974
Name:GOODMAN, SANDRA E (PHD, MFT)
Entity Type:Individual
Prefix:DR
First Name:SANDRA
Middle Name:E
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18623 VENTURA BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91356-6802
Mailing Address - Country:US
Mailing Address - Phone:818-905-8274
Mailing Address - Fax:818-774-0008
Practice Address - Street 1:14724 VENTURA BLVD STE 1100
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403-3511
Practice Address - Country:US
Practice Address - Phone:818-905-8274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT20063101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health