Healthcare Provider Details

I. General information

NPI: 1982255022
Provider Name (Legal Business Name): VENESSA ELIZABETH GOODMAN ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2019
Last Update Date: 10/06/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11512 B AVE
AUBURN CA
95603-2605
US

IV. Provider business mailing address

8840 STATE HIGHWAY 193
NEWCASTLE CA
95658-9682
US

V. Phone/Fax

Practice location:
  • Phone: 530-889-7229
  • Fax:
Mailing address:
  • Phone: 530-305-7310
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberASW115527
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: