Provider Demographics
NPI:1295053908
Name:GOODMAN, JESSICA Y (LCSW)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:Y
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824
Mailing Address - Country:US
Mailing Address - Phone:917-623-7765
Mailing Address - Fax:917-210-3426
Practice Address - Street 1:252 JAMES ST
Practice Address - Street 2:
Practice Address - City:FAIRFIELD
Practice Address - State:CT
Practice Address - Zip Code:06824-6475
Practice Address - Country:US
Practice Address - Phone:917-623-7765
Practice Address - Fax:917-210-3426
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0674581041C0700X
CT0078791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical