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General NPI Number Information
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NPI Number | 1790849974
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Entity Type | Individual
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Provider Name | SANDRA E GOODMAN PH.D., MFT
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Gender | Female
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Dates
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Enumeration Date | 12/21/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 14724 VENTURA BLVD STE 1100
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City | SHERMAN OAKS
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State | CA
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Zip | 91403-3511
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Country | US
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Telephone | 818-905-8274
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Fax |
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Provider Business Mailing Address
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Address Line | 18623 VENTURA BLVD STE 212
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City | TARZANA
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State | CA
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Zip | 91356-6802
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Country | US
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Telephone | 818-905-8274
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Fax | 818-774-0008
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MFT20063
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License Number State | CA
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