Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | PS006644L | PA |
Y | 103TC0700X | Clinical Psychologist | PS006644L | PA |
NPI | 1003983396 |
---|---|
Provider Name | Dr. Dana F Goode |
First Address | Philadelphia, PA 19107 |
Second Address | Philadelphia, PA 19107 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 29/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0686465000 | PERSONAL CHOICE (01) | |
7323085 | AETNA (01) |