Carolyn Suzanne Golden, PSY.D
Individual provider Active NPI Clinical Psychologist · Meridian, ID
NPI 1740314228 · NPPES record last updated Apr 9, 2012
Key facts
- NPI
- 1740314228
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY-202329 (ID)
- Practice address
- 2076 S Eagle Rd
Meridian, ID 83642-6707 - Phone
- (208) 955-7333
- Fax
- (208) 955-7330
- NPI assigned
- Mar 15, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in ID
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: No · Power mobility devices: No · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20140814002779 | ID | Practitioner - Clinical Psychologist | 9234356213 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY-202329 | ID | MD | Family Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Northwest Neurobehavioral Health, LLC | Clinical | Current |
Accepting new patients |
| Northwest Neurobehavioral Health PLLC | Clinical | Past | Accepting new patients |
Locations
2965 E Tarpon Dr
Ste 150
Meridian, ID 83642
Phone 2082879420110
2463 E Gala St
Ste 100
Meridian, ID 83642
Phone (208) 955-7333
2076 S Eagle Rd
Meridian, ID 83642
Phone (208) 955-7333
2463 E Gala St
Meridian, ID 83642
Phone (208) 908-1881
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY-202329 | ID | Yes |
| Family Psychologist | 103TF0000X | PSY-202329 | ID |
Addresses
Primary practice location
2076 S Eagle Rd
Meridian, ID 83642-6707
Mailing address
2076 S Eagle Rd
Meridian, ID 83642-6707
Phone (208) 955-7339
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 002269500 | Medicaid | ID | |
| 000010159469 | Other | ID | REGENCE BLUE SHIELD |
| N6295 | Other | ID | BLUE CROSS OF IDAHO |
Other providers in Meridian, ID
- Chad Gold
- Michael L. Gold
- Marcel Alexander Goldberg
- Andrea Goldberger
- Golden Angel Residential Assisted Living
- Olyvia J Golleher
- Brian W Goltry
- Brittany Gonzales
- Dane David Gonzales
- Gladys Joana Gonzales
All providers in Meridian, ID · Clinical Psychologist in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 9, 2012. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.