Provider Demographics
NPI:1972038198
Name:GOODMAN, ANIKKA L (LMFT)
Entity Type:Individual
Prefix:MS
First Name:ANIKKA
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:
Mailing Address - City:VALLEY FORD
Mailing Address - State:CA
Mailing Address - Zip Code:94972-0358
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:350 90TH ST FL 2
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94015-1879
Practice Address - Country:US
Practice Address - Phone:650-301-8662
Practice Address - Fax:650-877-5486
Is Sole Proprietor?:No
Enumeration Date:2017-04-25
Last Update Date:2022-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA131001106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist