Healthcare Provider Details

I. General information

NPI: 1942270541
Provider Name (Legal Business Name): ERIC DAVID GOODMAN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 06/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1194 PACIFIC ST STE 101 SUITE B-2
SAN LUIS OBISPO CA
93401-3338
US

IV. Provider business mailing address

1194 PACIFIC ST STE 101 SUITE B-2
SAN LUIS OBISPO CA
93401-3338
US

V. Phone/Fax

Practice location:
  • Phone: 805-473-3388
  • Fax: 805-548-0815
Mailing address:
  • Phone: 805-473-3388
  • Fax: 805-548-0815

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 20248
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY 20248
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: