Anneliese Mariah Goodman

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-20-125102 Issued in KY

Practice address

363 W Lincoln Trail Blvd
Radcliff, KY 40160-3302

Phone

(270) 352-1133

NPI assigned

Jun 24, 2020

Last updated

Jul 5, 2022By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other names 1

• Ms. Anneliese Mariah Gordon Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Early Intervention and Consultation Services, LLC

  dba Eics, LLC

  • Adolescent and Children Mental Health Clinic/Center
  • Leitchfield, KY
  • NPI 1780092957
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1592956800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1656979200000",
    "number": "1427674597",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1115 REGENCY WAY APT C",
            "city": "ELIZABETHTOWN",
            "state": "KY",
            "postal_code": "427017181",
            "telephone_number": "803-335-9085"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "363 W LINCOLN TRAIL BLVD",
            "city": "RADCLIFF",
            "state": "KY",
            "postal_code": "401603302",
            "telephone_number": "270-352-1133"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "ANNELIESE",
        "middle_name": "MARIAH",
        "name_prefix": "Mrs.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-06-24",
        "last_updated": "2022-07-05",
        "certification_date": "2022-07-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "KY",
            "license": "RBT-20-125102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "ANNELIESE",
            "last_name": "GORDON",
            "middle_name": "MARIAH",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Brandy Dawn Givan, M.A., CCC-SLP
• Glimmer of Hope, PLLC
• Mikayla Nicole Goff, MSW CSW
• Orlando Gonzalez, D.M.D.
• Sara M Goodin, M.A., L.P.A.
• Graham Behavioral Health, LLC
• Isabella Graziani
• Guiding Lights PLC (Lincoln Trail Adult Day care)
• Kristopher Hall I
• Elyse Marie Hardesty, ARNP

• Behavior Technician in Radcliff, KY
• Providers in Radcliff, KY by specialty
• Behavior Technician in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 5, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.