Provider Demographics
NPI:1104171560
Name:GOODENOUGH, HEATHER MICHELLE (MS ED)
Entity type:Individual
Prefix:MISS
First Name:HEATHER
Middle Name:MICHELLE
Last Name:GOODENOUGH
Suffix:
Gender:F
Credentials:MS ED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87 BUFFALO AVE
Mailing Address - Street 2:
Mailing Address - City:EAST ATLANTIC BEACH
Mailing Address - State:NY
Mailing Address - Zip Code:11561
Mailing Address - Country:US
Mailing Address - Phone:413-374-8269
Mailing Address - Fax:
Practice Address - Street 1:352 WEST 35 TH ST
Practice Address - Street 2:16 TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001
Practice Address - Country:US
Practice Address - Phone:718-728-8476
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-20
Last Update Date:2012-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist