Provider Demographics
NPI:1497159925
Name:GOODMAN, STEPHEN ROBERT (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:ROBERT
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PONDEROSA ST
Mailing Address - Street 2:
Mailing Address - City:LA PUENTE
Mailing Address - State:CA
Mailing Address - Zip Code:91744-6218
Mailing Address - Country:US
Mailing Address - Phone:626-318-7376
Mailing Address - Fax:626-330-4289
Practice Address - Street 1:101 PONDEROSA ST
Practice Address - Street 2:
Practice Address - City:LA PUENTE
Practice Address - State:CA
Practice Address - Zip Code:91744-6218
Practice Address - Country:US
Practice Address - Phone:626-318-7376
Practice Address - Fax:626-330-4289
Is Sole Proprietor?:No
Enumeration Date:2014-10-13
Last Update Date:2014-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW632831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical