Provider Demographics
NPI:1063260453
Name:GOODYEAR, ELIZABETH CLAIRE (MHC-LP)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:CLAIRE
Last Name:GOODYEAR
Suffix:
Gender:F
Credentials:MHC-LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 S MAGNOLIA ST APT 2
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2224
Mailing Address - Country:US
Mailing Address - Phone:845-642-0589
Mailing Address - Fax:
Practice Address - Street 1:16 MIDDLE NECK RD STE 537
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-2357
Practice Address - Country:US
Practice Address - Phone:917-912-2925
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-09
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP127736101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health