Provider Demographics
NPI:1649305426
Name:GOODFRIEND, RONNIE STEPHANIE (EDD)
Entity type:Individual
Prefix:DR
First Name:RONNIE
Middle Name:STEPHANIE
Last Name:GOODFRIEND
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11020 71ST ROAD
Mailing Address - Street 2:APT 903
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-4908
Mailing Address - Country:US
Mailing Address - Phone:718-263-0991
Mailing Address - Fax:718-237-5994
Practice Address - Street 1:11048 72ND AVENUE
Practice Address - Street 2:APT 3C
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-263-0991
Practice Address - Fax:718-237-5994
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006292103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist