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NPI Code Detail

MEDICARE: ALAN GOODSTAT LCSW

MEDICARE: ALAN GOODSTAT LCSW
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
11041C0700XClinical Social WorkerC012227NC

General Provider Information

NPI Number : 1306455316
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALAN GOODSTAT LCSW
Provider Business Mailing Address
First Line : 6619 NW 97TH LN
Second Line :
City : PARKLAND
State : FL
Zip : 33076-2339
Country : US
Telephone Number : 954-415-0758
Fax Number :
Provider Business Practice Location Address
First Line : 8509 CROWN CRESCENT CT
Second Line :
City : CHARLOTTE
State : NC
Zip : 28227-7733
Country : US
Telephone Number : 704-288-1097
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/26/2020
Last Update Date : 11/27/2020

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