Active NPI
Cary K Goodman, PH.D.
- Clinical Psychologist
- Fairfield, CT
National Provider Identifier
1679668875
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 2056
- Practice address
- 2335 Black Rock Tpke
Fairfield, CT 06825 - Phone
- (203) 334-7411
- Fax
- (203) 372-7596
- NPI assigned
- Oct 4, 2006
- Last updated
- Jul 8, 2007
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 2056 | CT | Primary |
Addresses
Primary practice location
2335 Black Rock Tpke
Fairfield, CT 06825
Mailing address
63 Sherley Place
Fairfield, CT 06825
Phone (203) 576-1371
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 353667 | Other | CT | MHN |
| 004250370 | Medicaid | CT | |
| 060002056CT01 | Other | CT | ANTEHM BC BS |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2056 | CT | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159920000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1679668875",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "63 SHERLEY PLACE",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "06825",
"telephone_number": "203-576-1371"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2335 BLACK ROCK TPKE",
"city": "FAIRFIELD",
"state": "CT",
"postal_code": "06825",
"telephone_number": "203-334-7411",
"fax_number": "203-372-7596"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOODMAN",
"first_name": "CARY",
"middle_name": "K",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-10-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CT",
"license": "2056",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHN",
"identifier": "353667",
"state": "CT"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "004250370",
"state": "CT"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "ANTEHM BC BS",
"identifier": "060002056CT01",
"state": "CT"
}
],
"endpoints": [],
"other_names": []
}Other providers in Fairfield, CT
Sources for this page
- 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.