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General NPI Number Information
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NPI Number | 1801178520
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Entity Type | Individual
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Provider Name | STANLEY JOEL GOODMAN NP
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Gender | Male
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Dates
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Enumeration Date | 09/20/2011
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Last Update Date | 08/21/2016
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Provider Practice Location Address
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Address Line | 67 UNION ST
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City | NATICK
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State | MA
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Zip | 01760-7700
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Country | US
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Telephone | 508-650-7000
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Fax |
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Provider Business Mailing Address
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Address Line | 5 TUCKERDALE WAY
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City | MILLIS
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State | MA
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Zip | 02054-1293
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Country | US
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Telephone | 508-523-2878
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | RN278637
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License Number State | MA
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