MEDICARE: MS. MARITTA VERA GOODMAN MA, LMFT

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	106H00000X	Marriage & Family Therapist	660	CO

General Provider Information

NPI Number	:	1316994262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. MARITTA VERA GOODMAN MA, LMFT

Provider Business Mailing Address
First Line	:	815 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4718
Country	:	US
Telephone Number	:	719-635-5528
Fax Number	:	719-488-2060

Provider Business Practice Location Address
First Line	:	815 N NEVADA AVE
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80903-4726
Country	:	US
Telephone Number	:	719-635-5528
Fax Number	:	719-488-2060

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

Provider Enumeration Date	:	05/27/2006
Last Update Date	:	07/08/2007

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