Goffman, Jerry M

Goffman, Jerry M is an sole proprietor health care provider with primary practice located at 8253 White Oak Ave , Rancho Cucamonga CA 91730-7671. He recently has only one registered license in Behavioral Health & Social Service Providers / Psychologist, which is considered as his primary health care specialty. Goffman, Jerry M can be contacted via phone (951) 312-1041.

Contact Information

Primary practice address
8253 White Oak Ave Rancho Cucamonga CA 91730-7671
Phone: (951) 312-1041
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Psychologist 103T00000X PSY7081 California

Profile Details

NPI number 1124137765
LBN Legal business name Goffman, Jerry M
Credentials PHD.
Entity Individual
Sole proprietor 1 Yes
Enumeration date Aug 29th, 2006
Last updated Oct 1st, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1124137765 NPPES
California MEDICAID PSY070812
California MEDICAID PSY070811

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