Healthcare Provider Details

I. General information

NPI: 1063711232
Provider Name (Legal Business Name): EDWARD GOETZ BA PSYCHOLOGY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2011
Last Update Date: 03/27/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

96 W COURT ST
DOYLESTOWN PA
18901-4213
US

IV. Provider business mailing address

96 W COURT ST
DOYLESTOWN PA
18901-4213
US

V. Phone/Fax

Practice location:
  • Phone: 215-348-8073
  • Fax:
Mailing address:
  • Phone: 215-348-8073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: