Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | LP5120 | MN |
Y | 103TC0700X | Clinical Psychologist | LP5120 | MN |
NPI | 1003048885 |
---|---|
Provider Name | Dr. Rebecca Goffman |
First Address | Anoka, MN 55303-9670 |
Second Address | New Hope, MN 55428-3019 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2009 |
Last Update Date | 27/10/2020 |