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NPI Code Detail

MEDICARE: DON M GOODMAN INC.

MEDICARE: DON M GOODMAN INC.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103TB0200XCognitive & Behavioral PsychologistPSY 22613CA
2103TH0004XHealth PsychologistPSY 22613CA
3103TP2701XGroup Psychotherapy PsychologistPSY 22613CA
4103TC0700XClinical PsychologistPSY 22613CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11871724518OTHERCANPI

General Provider Information

NPI Number : 1023342805
Entity Type Code : Organization
Provider Name (Legal Business Name) : DON M GOODMAN INC.
Provider Business Mailing Address
First Line : 123 HODENCAMP RD STE 103
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-5833
Country : US
Telephone Number : 818-917-4524
Fax Number : 805-449-2942
Provider Business Practice Location Address
First Line : 123 HODENCAMP RD STE 103
Second Line :
City : THOUSAND OAKS
State : CA
Zip : 91360-5833
Country : US
Telephone Number : 818-917-4524
Fax Number : 800-878-7720
Authorized Official
Title or Position : CLINICAL PSYCHOLOGIST
Name : DR. DONALD MITCHELL GOODMAN
Credential : PH.D.
Telephone Number : 818-917-4524
Provider Enumeration Date : 09/25/2009
Last Update Date : 03/11/2024

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