Provider Demographics
NPI:1700535515
Name:GOODMAN, SYLVIA LU (MFT)
Entity type:Individual
Prefix:
First Name:SYLVIA
Middle Name:LU
Last Name:GOODMAN
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 613
Mailing Address - Street 2:
Mailing Address - City:WOODACRE
Mailing Address - State:CA
Mailing Address - Zip Code:94973-0613
Mailing Address - Country:US
Mailing Address - Phone:415-786-5392
Mailing Address - Fax:
Practice Address - Street 1:239 MILLER AVE STE 3
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-2866
Practice Address - Country:US
Practice Address - Phone:415-455-4774
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-20
Last Update Date:2022-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC37612106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist