MEDICARE: DR. ERICA M. GOODSTONE PH.D.

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
1	225700000X	Massage Therapist	MA008892	FL
2	101YM0800X	Mental Health Counselor	MH0001738	FL
3	106H00000X	Marriage & Family Therapist	37FI01231	NJ
4	225700000X	Massage Therapist	004187	NY
5	101YP2500X	Professional Counselor	001649	CT
6	225700000X	Massage Therapist	001505	CT

General Provider Information

NPI Number	:	1033148366
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ERICA M. GOODSTONE PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 1493
Second Line	:
City	:	DEERFIELD BEACH
State	:	FL
Zip	:	33443-1493
Country	:	US
Telephone Number	:	954-649-5228
Fax Number	:

Provider Business Practice Location Address
First Line	:	1228 HILLSBORO MILE
Second Line	:	APT 105
City	:	HILLSBORO BEACH
State	:	FL
Zip	:	33062-1341
Country	:	US
Telephone Number	:	954-649-5228
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2006
Last Update Date	:	03/02/2015

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