Provider Demographics
NPI:1144624800
Name:GOODMAN, JULIE RACHEL (LICSW, SUDP)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:RACHEL
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:LICSW, SUDP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1902 2ND AVE
Mailing Address - Street 2:SUITE 208
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1155
Mailing Address - Country:US
Mailing Address - Phone:206-956-9570
Mailing Address - Fax:206-448-8495
Practice Address - Street 1:33505 13TH PL S STE C
Practice Address - Street 2:
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-6337
Practice Address - Country:US
Practice Address - Phone:253-246-2433
Practice Address - Fax:253-838-1433
Is Sole Proprietor?:No
Enumeration Date:2014-10-09
Last Update Date:2024-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP61082751101YA0400X
WALW60833004104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)