Healthcare Provider Details

I. General information

NPI: 1568383131
Provider Name (Legal Business Name): JONATHAN GOODRICH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2130 CENTER ST STE 200
BERKELEY CA
94704-1386
US

IV. Provider business mailing address

1300 DELAWARE ST APT 26
BERKELEY CA
94702-1470
US

V. Phone/Fax

Practice location:
  • Phone: 510-548-8283
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: