Provider Demographics
NPI:1821115403
Name:GOODRICH, CARL D (PHD)
Entity Type:Individual
Prefix:DR
First Name:CARL
Middle Name:D
Last Name:GOODRICH
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 ROCKLEDGE PL
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-4014
Mailing Address - Country:US
Mailing Address - Phone:201-836-0658
Mailing Address - Fax:914-681-2284
Practice Address - Street 1:DAVIS AVE AT E POST RD
Practice Address - Street 2:WPHC-MHC (4-C)
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10601-4615
Practice Address - Country:US
Practice Address - Phone:914-681-1189
Practice Address - Fax:914-681-2284
Is Sole Proprietor?:No
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016736103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical