Provider Demographics
NPI:1962122135
Name:GOODMAN, ALEXANDRA ISABELLE (MA)
Entity type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ISABELLE
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 30925
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93130-0925
Mailing Address - Country:US
Mailing Address - Phone:805-403-7901
Mailing Address - Fax:
Practice Address - Street 1:30 W MISSION ST STE 7
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93101-0404
Practice Address - Country:US
Practice Address - Phone:805-403-7901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-29
Last Update Date:2022-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12191101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional