Active NPI
Henry J. Goetze, PH.D.
- Clinical Psychologist
- Avon, CO
National Provider Identifier
1053335232
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 3047
- Practice address
- 100 W. Beaver Creek Blvd
Suite 218
Avon, CO 81620-8572 - Phone
- (845) 594-4692
- Fax
- (845) 471-1815
- NPI assigned
- Jul 27, 2006
- Last updated
- Nov 13, 2008
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 007274 | NY | |
| Clinical Psychologist | 103TC0700X | 3047 | CO | Primary |
Addresses
Primary practice location
100 W. Beaver Creek Blvd
Suite 218
Avon, CO 81620-8572
Mailing address
PO Box 8572
100 W. Beaver Creek Blvd, Suite 218
Avon, CO 81620-8572
Phone (845) 594-4692
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 01-0592394 | Other | TAX ID |
Other names 1
- Dr. Henry J. Goetze
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
- Opted out of Medicare
- Yes, effective Jul 15, 2015 through Jul 15, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 3047 | CO | MD | Professional Counselor |
| 007274 | NY | MD | Occupational Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1153958400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1226534400000",
"number": "1053335232",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 8572",
"address_2": "100 W. BEAVER CREEK BLVD, SUITE 218",
"city": "AVON",
"state": "CO",
"postal_code": "816208572",
"telephone_number": "845-594-4692",
"fax_number": "845-471-1815"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "100 W. BEAVER CREEK BLVD",
"address_2": "SUITE 218",
"city": "AVON",
"state": "CO",
"postal_code": "816208572",
"telephone_number": "845-594-4692",
"fax_number": "845-471-1815"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOETZE",
"first_name": "HENRY",
"middle_name": "J.",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-07-27",
"last_updated": "2008-11-13",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NY",
"license": "007274",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CO",
"license": "3047",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TAX ID",
"identifier": "01-0592394",
"state": null
}
],
"endpoints": [],
"other_names": [
{
"first_name": "HENRY",
"last_name": "GOETZE",
"middle_name": "J.",
"prefix": "DR.",
"credential": "PH.D.",
"code": "2",
"type": "Professional Name"
}
]
}Other providers in Avon, CO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 13, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.