Provider Demographics
NPI:1174696132
Name:GOODMAN, JUDITH L (PHD)
Entity type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:L
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:337 S BEVERLY DR STE 106
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-4307
Mailing Address - Country:US
Mailing Address - Phone:310-556-3370
Mailing Address - Fax:310-876-1656
Practice Address - Street 1:337 S BEVERLY DR STE 106
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-4307
Practice Address - Country:US
Practice Address - Phone:310-556-3370
Practice Address - Fax:310-876-1656
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY14747103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical