Provider Demographics
NPI:1144693433
Name:GOODSPEED, PATRICIA ELLEN
Entity type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:ELLEN
Last Name:GOODSPEED
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:PATRICIA
Other - Middle Name:
Other - Last Name:GOODSPEED-GRANT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:EDD
Mailing Address - Street 1:46 PRINCE ST
Mailing Address - Street 2:LL 004
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14607-1023
Mailing Address - Country:US
Mailing Address - Phone:585-978-1836
Mailing Address - Fax:
Practice Address - Street 1:46 PRINCE ST
Practice Address - Street 2:LL 004
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14607-1023
Practice Address - Country:US
Practice Address - Phone:585-978-1836
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2015-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000790101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health