Healthcare Provider Details

I. General information

NPI: 1699683359
Provider Name (Legal Business Name): LAURIN GOODMAN
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2026
Last Update Date: 09/01/2026
Certification Date: 09/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6901 N CHARLES ST
TOWSON MD
21204-3711
US

IV. Provider business mailing address

6901 N CHARLES ST
TOWSON MD
21204-3711
US

V. Phone/Fax

Practice location:
  • Phone: 443-809-4130
  • Fax:
Mailing address:
  • Phone: 443-809-4130
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number1001467918
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: