Provider Demographics
NPI:1770371627
Name:GOODSON, AYLA
Entity type:Individual
Prefix:
First Name:AYLA
Middle Name:
Last Name:GOODSON
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 PAR DR
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19115-1025
Mailing Address - Country:US
Mailing Address - Phone:251-554-7507
Mailing Address - Fax:
Practice Address - Street 1:4508 BLAKISTON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19136-2405
Practice Address - Country:US
Practice Address - Phone:251-554-7507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician