Provider Demographics
NPI:1982890778
Name:GOODMAN, HOWARD P (MA, MFT)
Entity type:Individual
Prefix:
First Name:HOWARD
Middle Name:P
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1425 N SIERRA BONITA AVE APT 318
Mailing Address - Street 2:
Mailing Address - City:WEST HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90046-4197
Mailing Address - Country:US
Mailing Address - Phone:818-667-2782
Mailing Address - Fax:
Practice Address - Street 1:1425 N SIERRA BONITA AVE APT 318
Practice Address - Street 2:
Practice Address - City:WEST HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:90046-4197
Practice Address - Country:US
Practice Address - Phone:818-667-2782
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-14
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46896106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY$$$$$$$$$OtherSOCIAL SECURITY NUMBER