Healthcare Provider Details

I. General information

NPI: 1639210685
Provider Name (Legal Business Name): DANIEL C GOODMAN LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 10/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 BROADWAY
NEWBURGH NY
12550-6204
US

IV. Provider business mailing address

30 HARRIMAN DR
GOSHEN NY
10924-2410
US

V. Phone/Fax

Practice location:
  • Phone: 845-568-5260
  • Fax: 845-568-5213
Mailing address:
  • Phone: 845-291-2600
  • Fax: 845-291-2628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR058267
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: