Brian Goldberg, PSY.D., BCBA-D

Primary specialty

Intellectual & Developmental Disabilities PsychologistTaxonomy code 103TM1800X

License

017826 Issued in NY

Practice address

283 Commack Rd
Suite 205
Commack, NY 11725-6021

Phone

(516) 848-8551

NPI assigned

Nov 21, 2012

Last updated

Nov 21, 2012By the provider in NPPES

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• United Supports for Autism

  • Community/Behavioral Health Agency
  • Commack, NY
  • NPI 1124399928
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1353456000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1353456000000",
    "number": "1689918146",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "283 COMMACK RD",
            "address_2": "SUITE 205",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117256021",
            "telephone_number": "516-848-8551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "283 COMMACK RD",
            "address_2": "SUITE 205",
            "city": "COMMACK",
            "state": "NY",
            "postal_code": "117256021",
            "telephone_number": "516-848-8551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "BRIAN",
        "name_prefix": "Dr.",
        "credential": "PSY.D., BCBA-D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2012-11-21",
        "last_updated": "2012-11-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TM1800X",
            "taxonomy_group": "",
            "desc": "Psychologist, Intellectual & Developmental Disabilities",
            "state": "NY",
            "license": "017826",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Charles W. Gluck, LCSW-R
• Mary Gnieser, LCSW
• Dakota Godek
• Gold Coast Dermatology PC
• Gold Coast Physical Therapist and Physical Therapy Assistant PLLC (Gold Coast Physical Therapy and Sports Trainin)
• Zoe Goldberg, MD
• Robert Goldman, PSY.D.
• Victoria Leigh Goldson, PT
• Karah Goldstein, MHC-LP
• Susan Amy Goldstein, MS SPECIAL ED.

• Intellectual & Developmental Disabilities Psychologist in Commack, NY
• Providers in Commack, NY by specialty
• Intellectual & Developmental Disabilities Psychologist in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 21, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.