Provider Demographics
NPI:1588109342
Name:GOODE, JONATHAN (PSYD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:
Last Name:GOODE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4701 OLD SOPER RD APT 363
Mailing Address - Street 2:
Mailing Address - City:CAMP SPRINGS
Mailing Address - State:MD
Mailing Address - Zip Code:20746-4012
Mailing Address - Country:US
Mailing Address - Phone:202-271-0222
Mailing Address - Fax:202-806-7299
Practice Address - Street 1:1609 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 301
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-1034
Practice Address - Country:US
Practice Address - Phone:202-271-0222
Practice Address - Fax:202-806-7299
Is Sole Proprietor?:No
Enumeration Date:2017-01-03
Last Update Date:2017-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCPSY1001231103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist