Provider Demographics
NPI:1942270541
Name:GOODMAN, ERIC DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:DAVID
Last Name:GOODMAN
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 1:1194 PACIFIC ST STE 101
Mailing Address - Street 2:SUITE B-2
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-3338
Mailing Address - Country:US
Mailing Address - Phone:805-473-3388
Mailing Address - Fax:805-548-0815
Practice Address - Street 1:1194 PACIFIC ST STE 101
Practice Address - Street 2:SUITE B-2
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-3338
Practice Address - Country:US
Practice Address - Phone:805-473-3388
Practice Address - Fax:805-548-0815
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-25
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20248103T00000X, 103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP20248Medicare UPIN