Provider Demographics
NPI:1962545004
Name:GOODWINE, ARIELLA HANNA (MFT)
Entity type:Individual
Prefix:MRS
First Name:ARIELLA
Middle Name:HANNA
Last Name:GOODWINE
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:501 1ST AVE # 3
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94401-3213
Mailing Address - Country:US
Mailing Address - Phone:650-342-6980
Mailing Address - Fax:
Practice Address - Street 1:501 1ST AVE # 3
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94401-3213
Practice Address - Country:US
Practice Address - Phone:650-342-6980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist