Provider Demographics
NPI:1982018040
Name:GOODMAN, JORDAN (MS, LCPC)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MS, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 FREDERICK RD
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-5335
Mailing Address - Country:US
Mailing Address - Phone:443-341-6736
Mailing Address - Fax:
Practice Address - Street 1:1007 FREDERICK RD.
Practice Address - Street 2:SUITE 3A
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-5335
Practice Address - Country:US
Practice Address - Phone:443-341-6736
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-17
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLC6478101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional