MEDICARE: MARISSA I GOODMAN LMHC, LPC, NCC, QS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH13655	FL

General Provider Information

NPI Number	:	1154950947
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARISSA I GOODMAN LMHC, LPC, NCC, QS

Provider Business Mailing Address
First Line	:	1314 E LAS OLAS BLVD
Second Line	:	#1606
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301
Country	:	US
Telephone Number	:	754-444-6486
Fax Number	:

Provider Business Practice Location Address
First Line	:	1314 E LAS OLAS BLVD # 1606
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33301-2334
Country	:	US
Telephone Number	:	754-444-6486
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/03/2020
Last Update Date	:	03/13/2023

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