Individual
LARKERRA GOODSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
CPS
Contact information
Practice address
1336 ARROTT ST APT E15, PHILADELPHIA, PA 19124-3281
(215) 690-1661
Mailing address
7624 RUGBY ST, PHILADELPHIA, PA 19150-2610
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
11000
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
824657872
PA STATE
PA
01
—
824657873
PA STATE
PA
Enumeration date
04/03/2019
Last updated
04/03/2019
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