Provider Demographics
NPI:1871724518
Name:GOODMAN, DONALD MITCHELL (PHD)
Entity type:Individual
Prefix:DR
First Name:DONALD
Middle Name:MITCHELL
Last Name:GOODMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:270 26TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2543
Mailing Address - Country:US
Mailing Address - Phone:818-917-4524
Mailing Address - Fax:805-449-2042
Practice Address - Street 1:270 26TH ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90402-2543
Practice Address - Country:US
Practice Address - Phone:818-917-4524
Practice Address - Fax:800-878-7720
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-29
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 22613103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical