MEDICARE: MS. DEBRA L GOODMAN LSW

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	104100000X	Social Worker	44SL06456700	NJ

General Provider Information

NPI Number	:	1174226252
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. DEBRA L GOODMAN LSW

Provider Business Mailing Address
First Line	:	33 WESTVIEW RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-1223
Country	:	US
Telephone Number	:	973-912-8009
Fax Number	:

Provider Business Practice Location Address
First Line	:	33 WESTVIEW RD
Second Line	:
City	:	SHORT HILLS
State	:	NJ
Zip	:	07078-1223
Country	:	US
Telephone Number	:	973-912-8009
Fax Number	:

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

Provider Enumeration Date	:	03/27/2023
Last Update Date	:	03/27/2023

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