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General NPI Number Information
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NPI Number | 1427405463
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Entity Type | Organization
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Legal Business Name | SHELLEY Z GOODMAN
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Dates
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Enumeration Date | 05/19/2016
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Last Update Date | 05/19/2016
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Provider Practice Location Address
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Address Line | 7401 OLD YORK RD
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City | ELKINS PARK
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State | PA
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Zip | 19027-3005
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Country | US
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Telephone | 215-782-1297
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Fax | 215-754-0999
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Provider Business Mailing Address
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Address Line | 7857 SPRING AVE
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City | ELKINS PARK
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State | PA
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Zip | 19027-2619
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Country | US
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Telephone | 215-782-1297
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Fax | 215-754-0999
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Authorized Official
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Title or Position | PSYCHOLOGIST
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Name | SHELLEY Z GOODMAN
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Credential |
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Telephone | 215-782-1297
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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 | PS006393L
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License Number State | PA
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