Healthcare Provider Details

I. General information

NPI: 1831188291
Provider Name (Legal Business Name): REBECCA SUE GOODMAN PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 10/18/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 W MICHELTORENA ST SUITE B
SANTA BARBARA CA
93101-6522
US

IV. Provider business mailing address

22 W MICHELTORENA ST SUITE B
SANTA BARBARA CA
93101-6522
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-2644
  • Fax: 805-682-2118
Mailing address:
  • Phone: 805-563-2644
  • Fax: 805-682-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY 14559
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: