Michael W Goldberg, M.A.
Individual provider Active NPI School Psychologist · Dulce, NM
NPI 1043340987 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1043340987
- Entity type
- Individual (NPI type 1)
- Primary specialty
- School Psychologist 103TS0200X
- License
- 308194 (NM)
- Practice address
- 113 Hawk Drive
Dulce, NM 87528 - Phone
- (505) 759-2954
- Fax
- (505) 759-1349
- NPI assigned
- Mar 7, 2007
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Master of Arts
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 308194 | NM | MD | School Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Dulce Independent School District | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| School Psychologist | 103TS0200X | 308194 | NM | Yes |
Addresses
Primary practice location
113 Hawk Drive
Dulce, NM 87528
Mailing address
98 Bull Elk PL
Pagosa Springs, CO 81147-8511
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 27087859 | Medicaid | NM |
Other providers in Dulce, NM
- Sonja H Emerson
- Allen Michael Frey
- Ursula Michael Gabriel
- Reyna R Garcia
- Margaret Jean Gillean
- Yolandra Gomez
- Sharon Hope Greacen
- Steven Paul Gross
- Daniel Xethan Haire
- Patrick S Hogan
All providers in Dulce, NM · School Psychologist in New Mexico
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.