Provider Demographics
NPI:1316994262
Name:GOODMAN, MARITTA VERA (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:MARITTA
Middle Name:VERA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 N NEVADA AVE
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80903-4718
Mailing Address - Country:US
Mailing Address - Phone:719-635-5528
Mailing Address - Fax:719-488-2060
Practice Address - Street 1:815 N NEVADA AVE
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80903-4726
Practice Address - Country:US
Practice Address - Phone:719-635-5528
Practice Address - Fax:719-488-2060
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO660106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist