MEDICARE: DR. JONATHAN GOODE PSY.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	103T00000X	Psychologist	PSY1001231	DC

General Provider Information

NPI Number	:	1588109342
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JONATHAN GOODE PSY.D.

Provider Business Mailing Address
First Line	:	4701 OLD SOPER RD APT 363
Second Line	:
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746-4012
Country	:	US
Telephone Number	:	202-271-0222
Fax Number	:	202-806-7299

Provider Business Practice Location Address
First Line	:	1609 CONNECTICUT AVE NW
Second Line	:	SUITE 301
City	:	WASHINGTON
State	:	DC
Zip	:	20009-1034
Country	:	US
Telephone Number	:	202-271-0222
Fax Number	:	202-806-7299

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

Provider Enumeration Date	:	01/03/2017
Last Update Date	:	01/03/2017

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