Basic Information
| Provider Information | |||||||||
| NPI: | 1992318380 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | DR TINA GOODIN ENTERPRISES INC | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | |||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | |||||||||
| OtherFirstName: | |||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | |||||||||
| OtherLastNameType: | |||||||||
| Mailing Information | |||||||||
| Address1: | 249 ROYAL PALM WAY STE 301 | ||||||||
| Address2: | |||||||||
| City: | PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 334804333 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784559332 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | PSYCHOLOGY CENTER OF PALM BEACH | ||||||||
| Address2: | 249 ROYAL PALM WAY | ||||||||
| City: | PALM BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 33480 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5613011464 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2020 | ||||||||
| LastUpdateDate: | 08/26/2020 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
| NPIDeactivationDate: | |||||||||
| NPIReactivationDate: | |||||||||
| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | PIMENTEL | ||||||||
| AuthorizedOfficialFirstName: | SHARON | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OFFICE /BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 9784559332 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | |||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 08/24/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC1900X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Counseling |
No ID Information.