Provider Demographics
NPI:1881732915
Name:GOODFRIED, ALAN (MFT)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:GOODFRIED
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 1:1844 SAN MIGUEL DR.
Mailing Address - Street 2:#306A
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94596-4692
Mailing Address - Country:US
Mailing Address - Phone:510-502-0792
Mailing Address - Fax:510-778-1540
Practice Address - Street 1:1844 SAN MIGUEL DR
Practice Address - Street 2:#306A
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94596-4962
Practice Address - Country:US
Practice Address - Phone:510-502-0792
Practice Address - Fax:510-778-1540
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC23944106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist