Healthcare Provider Details

I. General information

NPI: 1821710278
Provider Name (Legal Business Name): ISAAC GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2022
Last Update Date: 04/09/2026
Certification Date: 04/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PONCETTA DR APT 108
DALY CITY CA
94015-1149
US

IV. Provider business mailing address

2360 IRVING ST
SAN FRANCISCO CA
94122-1621
US

V. Phone/Fax

Practice location:
  • Phone: 415-823-1724
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number162710
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: