Healthcare Provider Details

I. General information

NPI: 1457878803
Provider Name (Legal Business Name): GABRIELE GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/26/2017
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

43 QUAIL CT STE 111
WALNUT CREEK CA
94596-5546
US

IV. Provider business mailing address

34 CHIMNEY ROCK
OAKLAND CA
94605-4605
US

V. Phone/Fax

Practice location:
  • Phone: 925-954-1618
  • Fax:
Mailing address:
  • Phone: 510-967-3776
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberPSY29188
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: