Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PS002831L |
NPI | 1245394964 |
---|---|
Provider Name | Carl L Good |
First Address | Elizabethtown, PA 17022-2199 |
Second Address | Elizabethtown, PA 17022-2199 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
50053205 | CAPITAL BLUE CROSS (01) | PA |
61-01013 | EVERCARE (01) | PA |
706943H6X | MASONIC HOMES HEALTH CARE (01) | PA |