Provider Demographics
NPI:1306986765
Name:GOEBEL, AMY R
Entity type:Individual
Prefix:MRS
First Name:AMY
Middle Name:R
Last Name:GOEBEL
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:R
Other - Last Name:SCHLEIFMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:344 S BEACH ST
Mailing Address - Street 2:
Mailing Address - City:DAYTONA BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32114-5035
Mailing Address - Country:US
Mailing Address - Phone:386-258-7434
Mailing Address - Fax:386-258-2283
Practice Address - Street 1:344 S BEACH ST
Practice Address - Street 2:
Practice Address - City:DAYTONA BEACH
Practice Address - State:FL
Practice Address - Zip Code:32114-5035
Practice Address - Country:US
Practice Address - Phone:386-258-7434
Practice Address - Fax:386-258-2283
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker