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General NPI Number Information
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NPI Number | 1073196721
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Entity Type | Organization
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Legal Business Name | LUIGIA GOODMAN LLC
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Dates
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Enumeration Date | 04/30/2021
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Last Update Date | 04/30/2021
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Provider Practice Location Address
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Address Line | 5239 E 26TH AVE
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City | ANCHORAGE
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State | AK
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Zip | 99508-3853
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Country | US
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Telephone | 718-781-2255
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Fax |
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Provider Business Mailing Address
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Address Line | 2440 E TUDOR RD
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City | ANCHORAGE
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State | AK
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Zip | 99507-1185
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH CLINICIAN
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Name | LUIGIA GOODMAN
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Credential | LCSW, CDC I
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Telephone | 718-781-2255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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