Provider Demographics
NPI:1902080328
Name:GOODMAN, ALINE REBECCA (LMSW)
Entity Type:Individual
Prefix:MS
First Name:ALINE
Middle Name:REBECCA
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:142 SARANAC AVE APT 6
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14216-2448
Mailing Address - Country:US
Mailing Address - Phone:347-693-4161
Mailing Address - Fax:
Practice Address - Street 1:3350 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14214-1316
Practice Address - Country:US
Practice Address - Phone:716-835-4011
Practice Address - Fax:716-835-0253
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-20
Last Update Date:2023-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY072943101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty