Active NPI
Thomas Goldstein
- Behavior Technician
- St Augustine, FL
National Provider Identifier
1356955397
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 124 Capulet Dr
St Augustine, FL 32092-4537 - Phone
- (904) 429-7806
- NPI assigned
- Sep 8, 2020
- 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 |
|---|---|---|---|---|
| Group Psychotherapy Psychologist | 103TP2701X | |||
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
124 Capulet Dr
St Augustine, FL 32092-4537
Mailing address
300 International Pkwy Ste 200
Lake Mary, FL 32746-5028
Phone (866) 610-0580
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| K90367026 | Other | NY | EMPIRE BLUE CROSS |
| K9036702604 | Other | NY | EMBLEMHEALTH |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1599523200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1599523200000",
"number": "1356955397",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PKWY STE 200",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327465028",
"telephone_number": "866-610-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 CAPULET DR",
"city": "ST AUGUSTINE",
"state": "FL",
"postal_code": "320924537",
"telephone_number": "904-429-7806"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GOLDSTEIN",
"first_name": "THOMAS",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2020-09-08",
"last_updated": "2020-09-08",
"certification_date": "2020-09-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TP2701X",
"taxonomy_group": "",
"desc": "Psychologist, Group Psychotherapy",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMPIRE BLUE CROSS",
"identifier": "K90367026",
"state": "NY"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "EMBLEMHEALTH",
"identifier": "K9036702604",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in St Augustine, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 8, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.