Healthcare Provider Details

I. General information

NPI: 1003983396
Provider Name (Legal Business Name): DANA F GOODE PSY D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1315 WALNUT STREET SUITE 1700
PHILADELPHIA PA
19107
US

IV. Provider business mailing address

1315 WALNUT STREET SUITE 1700
PHILADELPHIA PA
19107
US

V. Phone/Fax

Practice location:
  • Phone: 215-925-5456
  • Fax: 215-545-8496
Mailing address:
  • Phone: 215-925-5456
  • Fax: 215-545-8496

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS006644L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: