Provider Demographics
NPI:1700936382
Name:GOODRIDGE, DEBRA
Entity Type:Individual
Prefix:MS
First Name:DEBRA
Middle Name:
Last Name:GOODRIDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 W GAY ST
Mailing Address - Street 2:APARTMENT A
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19380-2801
Mailing Address - Country:US
Mailing Address - Phone:610-383-5635
Mailing Address - Fax:610-383-6581
Practice Address - Street 1:31 S 10TH AVE
Practice Address - Street 2:
Practice Address - City:COATESVILLE
Practice Address - State:PA
Practice Address - Zip Code:19320-3561
Practice Address - Country:US
Practice Address - Phone:610-383-5635
Practice Address - Fax:610-383-6581
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0152341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical