Doctor Name: | DR. MATTHEW READER GOODMAN |
NPI Number: | 1013181056 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 20147 |
Business Practice Address: | 2222 Bancroft Way Spc 4300 Berkeley, CA - 947204300 |
Business Phone Number: | 5106420695 |
Business Fax Number: | |
Mailing Address: | 2222 Bancroft Way Spc 4300, BERKELEY |
State: | CA |
Postal Code: | 947204300 |
Phone Number: | 5106420695 |
Fax Number: | |
NPI Enumeration Date: | 04/22/2008 |
NPI Last Update Date: | 04/22/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC1900X |
License Number: | 20147 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Counseling |
Taxonomy Definition: |