Healthcare Provider Details

I. General information

NPI: 1649763509
Provider Name (Legal Business Name): KATHERINE ELIZABETH GOODMAN ED.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2018
Last Update Date: 06/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 S CARLIN SPRINGS RD
ARLINGTON VA
22204-1014
US

IV. Provider business mailing address

421 N ALFRED ST
ALEXANDRIA VA
22314-2256
US

V. Phone/Fax

Practice location:
  • Phone: 703-228-6800
  • Fax:
Mailing address:
  • Phone: 703-909-1113
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number0813000964
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: