Provider Demographics
NPI:1831188853
Name:GOFF, FELICE BERSHAD (LCSW)
Entity type:Individual
Prefix:MRS
First Name:FELICE
Middle Name:BERSHAD
Last Name:GOFF
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11811 N TATUM BLVD
Mailing Address - Street 2:STE 3031
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85028-1614
Mailing Address - Country:US
Mailing Address - Phone:602-569-2900
Mailing Address - Fax:602-482-0120
Practice Address - Street 1:11811 N TATUM BLVD
Practice Address - Street 2:STE 3031
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85028-1614
Practice Address - Country:US
Practice Address - Phone:602-569-2900
Practice Address - Fax:602-482-0120
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-0749104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ68885Medicare ID - Type Unspecified