| Doctor Name: | DR. JAY A. GOODMAN |
| NPI Number: | 1134237779 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | PH. D. |
| License Number: | PSY11430 |
| Business Practice Address: | 54 Penny Ln Suite B Watsonville, CA - 950766012 |
| Business Phone Number: | 8317283189 |
| Business Fax Number: | 8316620756 |
| Mailing Address: | 54 Penny Ln, Suite B WATSONVILLE |
| State: | CA |
| Postal Code: | 950766012 |
| Phone Number: | 8317283189 |
| Fax Number: | 8316620756 |
| NPI Enumeration Date: | 08/25/2006 |
| NPI Last Update Date: | 09/18/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 103TC0700X |
| License Number: | PSY11430 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Psychologist |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | |