Frederick Greg Goodrich, PHD
Individual provider Active NPI Psychologist · Bayshore, NY
NPI 1316007453 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1316007453
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 08100 (NY)
- Practice address
- 260 W Main St
Ste 7
Bayshore, NY 11706 - Phone
- (631) 665-3768
- Fax
- (631) 665-3768
- NPI assigned
- Dec 11, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 08100 | NY | MD | Psychologist |
| 008100 | NY | MD | Massage Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| United Counseling Services LCSW PLLC | Past | Accepting new patients | |
| North Bellmore Psychological Services Ind | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 08100 | NY | Yes |
Addresses
Primary practice location
260 W Main St
Ste 7
Bayshore, NY 11706
Mailing address
260 W Main St
Ste 7
Bayshore, NY 11706
Phone (631) 665-3768
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00918332 | Medicaid | NY |
Other providers in Bayshore, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.