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General NPI Number Information
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NPI Number | 1265512362
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Entity Type | Individual
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Provider Name | DAVID GOODWIN PHD
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Gender | Male
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 4200 MONUMENT ROAD
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City | PHILADELPHIA
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State | PA
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Zip | 19131
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Country | US
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Telephone | 215-581-9110
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Fax | 215-581-3827
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Provider Business Mailing Address
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Address Line | 115 MERBROOK LN
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City | MERION STATION
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State | PA
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Zip | 19066-1619
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Country | US
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Telephone | 215-581-9110
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Fax | 215-581-3827
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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 | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS006256L
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License Number State | PA
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