Healthcare Provider Details

I. General information

NPI: 1306906136
Provider Name (Legal Business Name): JANICE HANSEN GOODMAN PHD, APRN, BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

599 NORTH AVENUE
WAKEFIELD MA
01801
US

IV. Provider business mailing address

69 MYSTIC VALLEY PKWY
WINCHESTER MA
01890-2936
US

V. Phone/Fax

Practice location:
  • Phone: 781-775-4963
  • Fax:
Mailing address:
  • Phone: 781-775-4963
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License Number163553
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: