Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TH0004X | Health Psychologist | PSY29188 | CA |
NPI | 1457878803 |
---|---|
Provider Name | Gabriele Goodman |
First Address | Oakland, CA 94605-4605 |
Second Address | Walnut Creek, CA 94596-5546 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/08/2017 |
Last Update Date | 17/03/2018 |