MEDICARE: MATTHEW ROBERT GOODNOW PSY.D, HSP

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	11494	MA

General Provider Information

NPI Number	:	1669056214
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW ROBERT GOODNOW PSY.D, HSP

Provider Business Mailing Address
First Line	:	12 SPRING ST FL 1
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-3314
Country	:	US
Telephone Number	:	617-207-4124
Fax Number	:	617-841-7598

Provider Business Practice Location Address
First Line	:	12 SPRING ST
Second Line	:
City	:	MARBLEHEAD
State	:	MA
Zip	:	01945-3314
Country	:	US
Telephone Number	:	617-207-4124
Fax Number	:

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

Provider Enumeration Date	:	05/10/2021
Last Update Date	:	05/10/2021

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