Provider Demographics
NPI:1962836973
Name:GOODMAN, GIZELA GALI (LCSW, MSED)
Entity type:Individual
Prefix:
First Name:GIZELA
Middle Name:GALI
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LCSW, MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 CHURCHILL RD
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-2900
Mailing Address - Country:US
Mailing Address - Phone:201-870-0331
Mailing Address - Fax:
Practice Address - Street 1:20 N VAN BRUNT ST STE 2
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07631-2715
Practice Address - Country:US
Practice Address - Phone:201-870-0331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-27
Last Update Date:2020-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY088441041C0700X
NJ44SC058722001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical