Healthcare Provider Details

I. General information

NPI: 1740302454
Provider Name (Legal Business Name): CYNTHIA GOODMAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 UNION ST
SCHENECTADY NY
12309-6003
US

IV. Provider business mailing address

1509 UNION ST
SCHENECTADY NY
12309-6003
US

V. Phone/Fax

Practice location:
  • Phone: 518-346-7303
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberF400308-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: