Provider Demographics
NPI:1063573293
Name:GOODMAN, LYNNETTE JOY (LCSW)
Entity type:Individual
Prefix:
First Name:LYNNETTE
Middle Name:JOY
Last Name:GOODMAN
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 1:122 WESSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:GARFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07026-3208
Mailing Address - Country:US
Mailing Address - Phone:973-772-4738
Mailing Address - Fax:973-772-7965
Practice Address - Street 1:33-11 BROADWAY
Practice Address - Street 2:SUITE 206
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-4634
Practice Address - Country:US
Practice Address - Phone:973-772-4738
Practice Address - Fax:973-772-7965
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC006043001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical