Provider Demographics
NPI:1447304928
Name:GOODELL, SUSAN CAROL (MFT)
Entity type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:CAROL
Last Name:GOODELL
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 2328
Mailing Address - Street 2:
Mailing Address - City:DEL MAR
Mailing Address - State:CA
Mailing Address - Zip Code:92014-1628
Mailing Address - Country:US
Mailing Address - Phone:619-997-5333
Mailing Address - Fax:619-222-0788
Practice Address - Street 1:2140 VIA MAR VALLE
Practice Address - Street 2:
Practice Address - City:DEL MAR
Practice Address - State:CA
Practice Address - Zip Code:92014-3627
Practice Address - Country:US
Practice Address - Phone:619-997-5333
Practice Address - Fax:619-222-0788
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 20533106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist