Provider Demographics
NPI:1477740082
Name:GOODMAN, ALAN MARTIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ALAN
Middle Name:MARTIN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:A
Other - Middle Name:MARTIN
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:17337 VENTURA BLVD
Mailing Address - Street 2:#320
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316
Mailing Address - Country:US
Mailing Address - Phone:818-788-7733
Mailing Address - Fax:818-788-7734
Practice Address - Street 1:17337 VENTURA BLVD
Practice Address - Street 2:#320
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316
Practice Address - Country:US
Practice Address - Phone:818-788-7733
Practice Address - Fax:818-788-7734
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-27
Last Update Date:2007-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12212103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist