Healthcare Provider Details

I. General information

NPI: 1225951239
Provider Name (Legal Business Name): BRIAN MITCHELL GOODYEAR
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2026
Last Update Date: 08/04/2026
Certification Date: 08/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 PATRIOT DR STE A-5
MIDDLETOWN DE
19709-8803
US

IV. Provider business mailing address

108 PATRIOT DR STE A-5
MIDDLETOWN DE
19709-8803
US

V. Phone/Fax

Practice location:
  • Phone: 888-433-3201
  • Fax:
Mailing address:
  • Phone: 888-433-3201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: