Jeffrey Samuel Goodman, PHD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

0810001065 Issued in VA

Practice address

355 Crawford St
Suite 804
Portsmouth, VA 23704-2816

Phone

(757) 397-4394

Fax

(757) 397-3990

NPI assigned

Jul 7, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

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

{
    "created_epoch": "1152230400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1528091402",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "355 CRAWFORD ST",
            "address_2": "SUITE 804",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042816",
            "telephone_number": "757-397-4394",
            "fax_number": "757-397-3990"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "355 CRAWFORD ST",
            "address_2": "SUITE 804",
            "city": "PORTSMOUTH",
            "state": "VA",
            "postal_code": "237042816",
            "telephone_number": "757-397-4394",
            "fax_number": "757-397-3990"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOODMAN",
        "first_name": "JEFFREY",
        "middle_name": "SAMUEL",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-07",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810001065",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "007758201",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Edwin Gonzalez, M.D.
• Hermann Francisco Gonzalez, D.O.
• Cheniqua Bene' Goode, LPC
• Lakeisha Goode, PHARMD
• John F Goodhart, PA
• Kevin David Goodman, M.D.
• Stephanie T Goodrich, RN
• Kristine Goodwyn
• Cindylee Ann Gordish, MSED, CCC-SLP
• Brian Keith Gordon, DMD

• Clinical Psychologist in Portsmouth, VA
• Providers in Portsmouth, VA by specialty
• Clinical Psychologist in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.