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General NPI Number Information
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NPI Number | 1497004808
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Entity Type | Individual
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Provider Name | ELIZABETH JANUARY GOODMAN LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/30/2012
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Last Update Date | 08/30/2012
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Provider Practice Location Address
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Address Line | 61 W 62ND ST APT 4F
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City | NEW YORK
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State | NY
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Zip | 10023-7016
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Country | US
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Telephone | 212-586-3773
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Fax |
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Provider Business Mailing Address
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Address Line | 102 S ELLIOTT PL
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City | BROOKLYN
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State | NY
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Zip | 11217-1509
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Country | US
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Telephone | 917-747-5871
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 076462-1
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License Number State | NY
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