Provider Demographics
NPI:1396025300
Name:GOODEARL, ANNA WARD (PHD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:WARD
Last Name:GOODEARL
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 1:1667 YORK AVE
Mailing Address - Street 2:APT 4N
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-6565
Mailing Address - Country:US
Mailing Address - Phone:718-813-3506
Mailing Address - Fax:
Practice Address - Street 1:1165 MORRIS PARK AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10461-1915
Practice Address - Country:US
Practice Address - Phone:718-430-3907
Practice Address - Fax:718-430-3989
Is Sole Proprietor?:No
Enumeration Date:2011-08-22
Last Update Date:2014-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist