Jeffrey A Goldman, PH.D
Individual provider Active NPI Clinical Psychologist · Stamford, NY
NPI 1700937133 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1700937133
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 4594 (NY)
- Practice address
- 32-34 Main St
Stamford, NY 12167-1145 - Phone
- (607) 652-2000
- Fax
- (607) 652-2433
- NPI assigned
- Jan 14, 2007
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4594 | NY | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4594 | NY | Yes |
Addresses
Primary practice location
32-34 Main St
Stamford, NY 12167-1145
Mailing address
32-34 Main St
Stamford, NY 12167-1145
Phone (607) 652-2000
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 580869 | Medicaid | NY |
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All providers in Stamford, NY · Clinical Psychologist in New York
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.