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1114952314 NPI number — DIANE GOODMAN PSYD

NPI Number: 1114952314
Health Care Provider/Practitioner: DIANE GOODMAN PSYD

Information about “1114952314” NPI (DIANE GOODMAN PSYD) exists in 1114952314 in HTML format HTML  |  1114952314 in plain Text format TXT  |  1114952314 in PDF (Portable Document Format) PDF  |  1114952314 in an XML format XML  formats.

NPI Number : 1114952314 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1114952314",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GOODMAN",
    "FirstName": "DIANE",
    "MiddleName": null,
    "NamePrefix": "DR.",
    "NameSuffix": null,
    "Credential": "PSYD",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "515 JAMES ST",
    "SecondLineMailingAddress": "SUITE #1",
    "MailingAddressCityName": "GENEVA",
    "MailingAddressStateName": "IL",
    "MailingAddressPostalCode": "60134-2173",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "630-251-8434",
    "MailingAddressFaxNumber": "630-208-1044",
    "FirstLinePracticeLocationAddress": "515 JAMES ST STE 1",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "GENEVA",
    "PracticeLocationAddressStateName": "IL",
    "PracticeLocationAddressPostalCode": "60134-2187",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "630-251-8434",
    "PracticeLocationAddressFaxNumber": "630-208-1044",
    "EnumerationDate": "07/12/2006",
    "LastUpdateDate": "02/15/2011",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "103T00000X",
          "TaxonomyName": "Psychologist",
          "LicenseNumber": "071.008020",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "Y"
        },
        {
          "TaxonomyCode": "101YP2500X",
          "TaxonomyName": "Professional Counselor",
          "LicenseNumber": "180-002613",
          "LicenseNumberStateCode": "IL",
          "PrimaryTaxonomySwitch": "N"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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