MEDICARE: DAVID DANIEL GOODRICK PHD

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	103TC0700X	Clinical Psychologist	490-57	WI

General Provider Information

NPI Number	:	1982283578
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID DANIEL GOODRICK PHD

Provider Business Mailing Address
First Line	:	1039 HILLSBORO MILE APT 4
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-2104
Country	:	US
Telephone Number	:	954-815-6227
Fax Number	:

Provider Business Practice Location Address
First Line	:	1039 HILLSBORO MILE APT 4
Second Line	:
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-2104
Country	:	US
Telephone Number	:	954-815-6227
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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