Provider Demographics
NPI:1194875575
Name:GOODMAN, SHELLEY Z (PHD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:Z
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7857 SPRING AVE
Mailing Address - Street 2:
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-2619
Mailing Address - Country:US
Mailing Address - Phone:215-782-1297
Mailing Address - Fax:215-754-0999
Practice Address - Street 1:7401 OLD YORK RD
Practice Address - Street 2:
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3005
Practice Address - Country:US
Practice Address - Phone:215-782-1297
Practice Address - Fax:215-754-0999
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS006393-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA101274497001Medicaid
PA0007480038Medicare UPIN
PA104755000Medicare UPIN
PAGO438361Medicare PIN
PA0186225000Medicare UPIN
PA282606Medicare UPIN
PA101274497001Medicaid