Healthcare Provider Details

I. General information

NPI: 1700535515
Provider Name (Legal Business Name): SYLVIA LU GOODMAN MFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2022
Last Update Date: 03/20/2022
Certification Date: 03/20/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

239 MILLER AVE STE 3
MILL VALLEY CA
94941-2866
US

IV. Provider business mailing address

PO BOX 613
WOODACRE CA
94973-0613
US

V. Phone/Fax

Practice location:
  • Phone: 415-455-4774
  • Fax:
Mailing address:
  • Phone: 415-786-5392
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC37612
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: