Healthcare Provider Details

I. General information

NPI: 1447496930
Provider Name (Legal Business Name): DR. STANLEY LOUIS GOODMAN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: STANLEY LOUIS GOODMAN M.D.

II. Dates (important events)

Enumeration Date: 01/05/2009
Last Update Date: 05/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 BALBOA BLVD SUITE 215
ENCINO CA
91316-1516
US

IV. Provider business mailing address

5535 BALBOA BLVD SUITE 215
ENCINO CA
91316-1516
US

V. Phone/Fax

Practice location:
  • Phone: 818-986-7826
  • Fax: 818-986-7834
Mailing address:
  • Phone: 818-986-7826
  • Fax: 818-986-7834

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TP0016X
TaxonomyPrescribing (Medical) Psychologist
License NumberC039950
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: