Provider Demographics
NPI:1366228843
Name:GOODMAN, REBECCA SARAH
Entity type:Individual
Prefix:
First Name:REBECCA
Middle Name:SARAH
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6488
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92166-0488
Mailing Address - Country:US
Mailing Address - Phone:619-736-0172
Mailing Address - Fax:
Practice Address - Street 1:4025 CAMINO DEL RIO S UNIT 329
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92108-4107
Practice Address - Country:US
Practice Address - Phone:619-261-9269
Practice Address - Fax:619-618-0688
Is Sole Proprietor?:No
Enumeration Date:2023-08-31
Last Update Date:2024-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker