Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 20147 | CA |
NPI | 1013181056 |
---|---|
Provider Name | Dr. Matthew Reader Goodman |
First Address | Berkeley, CA 94720-4300 |
Second Address | Berkeley, CA 94720-4300 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2008 |
Last Update Date | 22/04/2008 |