Provider Demographics
NPI:1851440176
Name:GOODMAN, RITA LAWLER (PHD)
Entity Type:Individual
Prefix:DR
First Name:RITA
Middle Name:LAWLER
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:287 KIPLING CT
Mailing Address - Street 2:
Mailing Address - City:HEATHROW
Mailing Address - State:FL
Mailing Address - Zip Code:32746-4124
Mailing Address - Country:US
Mailing Address - Phone:404-540-1738
Mailing Address - Fax:407-423-2194
Practice Address - Street 1:1111 S ORANGE AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32806-1236
Practice Address - Country:US
Practice Address - Phone:407-540-1738
Practice Address - Fax:407-423-2194
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH971101YM0800X
FLMT607106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLMH971OtherST OF FL DEPT OF HEALTH
FLMT607OtherST OF FL DEPT OF HEALTH