Provider Demographics
NPI:1396192852
Name:GOLDMAN, REBECCA
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 NE 125TH ST
Mailing Address - Street 2:#18
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-4073
Mailing Address - Country:US
Mailing Address - Phone:206-939-0741
Mailing Address - Fax:
Practice Address - Street 1:1020 NE 125TH ST
Practice Address - Street 2:#18
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-4073
Practice Address - Country:US
Practice Address - Phone:206-939-0741
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-15
Last Update Date:2016-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst