Individual
EVAN MALCOLM GOODFELLOW
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1010 N HANCOCK ST, PHILADELPHIA, PA 19123-2334
(267) 807-0550
Mailing address
1256 S 20TH ST, PHILADELPHIA, PA 19146-4338
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
—
—
Other
Enumeration date
07/25/2023
Last updated
07/25/2023
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