Provider Demographics
NPI:1801447750
Name:GOODMAN, LAURA (MFT)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:518 E PALMER AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-3489
Mailing Address - Country:US
Mailing Address - Phone:310-987-9714
Mailing Address - Fax:
Practice Address - Street 1:222 E HUNTINGTON DR STE 211
Practice Address - Street 2:
Practice Address - City:MONROVIA
Practice Address - State:CA
Practice Address - Zip Code:91016-8006
Practice Address - Country:US
Practice Address - Phone:626-358-1564
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-23
Last Update Date:2019-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48405106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist