Individual
REVITAL GOODMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW
Contact information
Practice address
9858 GLADES RD # D3-218, BOCA RATON, FL 33434-3983
(323) 770-4777
Mailing address
9858 GLADES RD # D3-218, BOCA RATON, FL 33434-3983
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
SW 11854
FL
Other
Enumeration date
09/22/2014
Last updated
09/22/2014
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