Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 012811 | NY |
Y | 103TC0700X | Clinical Psychologist | 012811 | NY |
NPI | 1003941295 |
---|---|
Provider Name | Janet Goff |
First Address | Poughkeepsie, NY 12601 |
Second Address | Poughkeepsie, NY 12601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
012811 | LICENSE (01) | NY |