Healthcare Provider Details

I. General information

NPI: 1982168134
Provider Name (Legal Business Name): ELIZABETH GOODMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2019
Last Update Date: 01/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2305 N PARHAM RD STE 3
RICHMOND VA
23229-3156
US

IV. Provider business mailing address

2710 CLIFTON AVE
RICHMOND VA
23222-3709
US

V. Phone/Fax

Practice location:
  • Phone: 804-270-1124
  • Fax: 804-270-2090
Mailing address:
  • Phone: 703-473-1909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number0904010837
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: