MEDICARE: ANGELIQUE GOODMAN

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

General Provider Information

NPI Number	:	1588266571
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANGELIQUE GOODMAN

Provider Business Mailing Address
First Line	:	1705 VALDOSTA DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2840
Country	:	US
Telephone Number	:	513-570-1000
Fax Number	:	513-671-0216

Provider Business Practice Location Address
First Line	:	1705 VALDOSTA DR
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45246-2840
Country	:	US
Telephone Number	:	513-570-1000
Fax Number	:	513-671-0216

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

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	11/13/2020

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Directions to “ ANGELIQUE GOODMAN ” Practice Location

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