Provider Demographics
NPI:1740356419
Name:GOODMAN, JEFFREY M (MFT)
Entity type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:M
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3002 ARMSTRONG STREET
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92111
Mailing Address - Country:US
Mailing Address - Phone:858-277-9550
Mailing Address - Fax:858-279-2763
Practice Address - Street 1:3002 ARMSTRONG STREET
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92111
Practice Address - Country:US
Practice Address - Phone:858-277-9550
Practice Address - Fax:858-279-2763
Is Sole Proprietor?:No
Enumeration Date:2006-11-27
Last Update Date:2011-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA44055106H00000X
CAMFC 44055106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist