MEDICARE: JANAY GOODMAN PLMSW

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568822526
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANAY GOODMAN PLMSW

Provider Business Mailing Address
First Line	:	12004 ZIA RD NE APT C3
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87123-1447
Country	:	US
Telephone Number	:	505-401-4811
Fax Number	:

Provider Business Practice Location Address
First Line	:	3232 CANDELARIA RD NE
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87107-1907
Country	:	US
Telephone Number	:	505-323-3785
Fax Number	:

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

Provider Enumeration Date	:	03/02/2016
Last Update Date	:	12/01/2016

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