Healthcare Provider Details

I. General information

NPI: 1033148366
Provider Name (Legal Business Name): ERICA M. GOODSTONE PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1228 HILLSBORO MILE APT 105
HILLSBORO BEACH FL
33062-1341
US

IV. Provider business mailing address

PO BOX 1493
DEERFIELD BEACH FL
33443-1493
US

V. Phone/Fax

Practice location:
  • Phone: 954-649-5228
  • Fax:
Mailing address:
  • Phone: 954-649-5228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMA008892
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH0001738
License Number StateFL
# 3
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number37FI01231
License Number StateNJ
# 4
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number004187
License Number StateNY
# 5
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number001649
License Number StateCT
# 6
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number001505
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: