Provider Demographics
NPI:1013344837
Name:GOODMAN, MICHAEL DEAN (PHD, MINISTER)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DEAN
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHD, MINISTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6822 BRIDLEWOOD CT
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33433-3566
Mailing Address - Country:US
Mailing Address - Phone:561-350-3930
Mailing Address - Fax:
Practice Address - Street 1:6822 BRIDLEWOOD CT
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33433-3566
Practice Address - Country:US
Practice Address - Phone:561-350-3930
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-11
Last Update Date:2014-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral