Provider Demographics
NPI:1184002156
Name:GOODWIN, ALAN B (JD, PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:B
Last Name:GOODWIN
Suffix:
Gender:M
Credentials:JD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14320 VENTURA BLVD # 1129
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-2717
Mailing Address - Country:US
Mailing Address - Phone:323-445-8900
Mailing Address - Fax:323-345-5778
Practice Address - Street 1:14320 VENTURA BLVD # 1129
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-2717
Practice Address - Country:US
Practice Address - Phone:323-445-8900
Practice Address - Fax:323-345-5778
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-11
Last Update Date:2024-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19421103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologist