Provider Demographics
NPI:1447496930
Name:GOODMAN, STANLEY LOUIS
Entity type:Individual
Prefix:DR
First Name:STANLEY
Middle Name:LOUIS
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:STANLEY
Other - Middle Name:LOUIS
Other - Last Name:GOODMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5535 BALBOA BLVD
Mailing Address - Street 2:SUITE 215
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-1516
Mailing Address - Country:US
Mailing Address - Phone:818-986-7826
Mailing Address - Fax:818-986-7834
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:SUITE 215
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1516
Practice Address - Country:US
Practice Address - Phone:818-986-7826
Practice Address - Fax:818-986-7834
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2013-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAC039950103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)