MEDICARE: AMANDA GOODING PHD

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	103TC0700X	Clinical Psychologist	28757	CA
2	103TC0700X	Clinical Psychologist	021187	NY

General Provider Information

NPI Number	:	1265840755
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA GOODING PHD

Provider Business Mailing Address
First Line	:	4653 CARMEL MOUNTAIN RD STE 308
Second Line	:	PMB 1030
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-6650
Country	:	US
Telephone Number	:	858-380-5856
Fax Number	:

Provider Business Practice Location Address
First Line	:	350 DICKINSON ST FL 3
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-1913
Country	:	US
Telephone Number	:	619-543-6282
Fax Number	:

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

Provider Enumeration Date	:	07/28/2014
Last Update Date	:	04/08/2026

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Directions to “ AMANDA GOODING PHD” Practice Location

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