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General NPI Number Information
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NPI Number | 1457878803
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Entity Type | Individual
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Provider Name | GABRIELE GOODMAN
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Gender | Female
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Dates
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Enumeration Date | 08/26/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 43 QUAIL CT STE 111
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City | WALNUT CREEK
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State | CA
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Zip | 94596-5546
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Country | US
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Telephone | 925-954-1618
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Fax |
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Provider Business Mailing Address
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Address Line | 34 CHIMNEY ROCK
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City | OAKLAND
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State | CA
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Zip | 94605-4605
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Country | US
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Telephone | 510-967-3776
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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 | 103TH0004X
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Taxonomy Name | Health Psychologist
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License Number | PSY29188
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License Number State | CA
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