Provider Demographics
NPI:1194939967
Name:GOODMAN, HOWARD ALAN (PHD)
Entity type:Individual
Prefix:DR
First Name:HOWARD
Middle Name:ALAN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1361 ELM ST
Mailing Address - Street 2:SUITE # 400
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101-1324
Mailing Address - Country:US
Mailing Address - Phone:603-232-6987
Mailing Address - Fax:
Practice Address - Street 1:1361 ELM ST
Practice Address - Street 2:SUITE # 400
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101-1324
Practice Address - Country:US
Practice Address - Phone:603-232-6987
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-10
Last Update Date:2014-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH630101YM0800X
NH1302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH3083931Medicaid