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General NPI Number Information
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NPI Number | 1821115403
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Entity Type | Individual
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Provider Name | CARL D. GOODRICH PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/26/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | DAVIS AVE AT E POST RD WPHC-MHC (4-C)
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City | WHITE PLAINS
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State | NY
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Zip | 10601-4615
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Country | US
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Telephone | 914-681-1189
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Fax | 914-681-2284
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Provider Business Mailing Address
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Address Line | 359 ROCKLEDGE PL
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City | TEANECK
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State | NJ
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Zip | 07666-4014
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Country | US
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Telephone | 201-836-0658
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Fax | 914-681-2284
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 016736
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License Number State | NY
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