Active NPI
Alan Martin Goodman, PHD
- Psychologist
- Encino, CA
National Provider Identifier
1477740082
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- PSY12212
- Practice address
- 17337 Ventura Blvd
#320
Encino, CA 91316 - Phone
- (818) 788-7733
- Fax
- (818) 788-7734
- NPI assigned
- Sep 27, 2007
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | PSY12212 | CA | Primary |
Addresses
Primary practice location
17337 Ventura Blvd
#320
Encino, CA 91316
Mailing address
17337 Ventura Blvd
#320
Encino, CA 91316
Phone (818) 788-7733
Other names 1
- A Martin Goodman
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Apr 30, 2024 through Apr 30, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY12212 | CA | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1190851200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1190851200000",
"number": "1477740082",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "17337 VENTURA BLVD",
"address_2": "#320",
"city": "ENCINO",
"state": "CA",
"postal_code": "91316",
"telephone_number": "818-788-7733",
"fax_number": "818-788-7734"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "17337 VENTURA BLVD",
"address_2": "#320",
"city": "ENCINO",
"state": "CA",
"postal_code": "91316",
"telephone_number": "818-788-7733",
"fax_number": "818-788-7734"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "ALAN",
"middle_name": "MARTIN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2007-09-27",
"last_updated": "2007-09-27",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "CA",
"license": "PSY12212",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"first_name": "A",
"last_name": "GOODMAN",
"middle_name": "MARTIN",
"credential": "PHD",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Encino, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 27, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.