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General NPI Number Information
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NPI Number | 1013017672
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Entity Type | Individual
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Provider Name | MICHAELE E GOODMAN PH. D.
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Gender | Female
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 220 E 54TH ST SUITE #1C
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City | NEW YORK
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State | NY
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Zip | 10022-4837
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Country | US
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Telephone | 212-593-5740
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Fax |
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Provider Business Mailing Address
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Address Line | 34 PERRY AVE
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City | PORT CHESTER
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State | NY
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Zip | 10573-2920
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Country | US
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Telephone | 914-939-3414
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 009860
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License Number State | NY
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