Individual provider Active NPI

Kenneth Goldberg, PH.D.

  • Clinical Psychologist
  • Haddon Township, NJ
National Provider Identifier
1770992547
Registry record updated Aug 6, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
2258 Issued in NJ
Practice address
215 Highland Ave
Suite C
Haddon Township, NJ 08108-2634
Phone
(856) 547-4000
Fax
(856) 547-1118
NPI assigned
Aug 6, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 6, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 2258 NJ Primary

Addresses

Primary practice location

215 Highland Ave
Suite C
Haddon Township, NJ 08108-2634

Mailing address

PO Box 3702
Cherry Hill, NJ 08034-0569
Phone (856) 547-4000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200504000885 NJ Practitioner - Clinical Psychologist 8921439167 Practice locations: Haddon Township, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1976
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

215 Highland Ave
Suite C
Haddon Township, NJ 08108-2634
Phone (856) 547-4000

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
2258NJMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1407283200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1407283200000",
    "number": "1770992547",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3702",
            "city": "CHERRY HILL",
            "state": "NJ",
            "postal_code": "080340569",
            "telephone_number": "856-547-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 HIGHLAND AVE",
            "address_2": "SUITE C",
            "city": "HADDON TOWNSHIP",
            "state": "NJ",
            "postal_code": "081082634",
            "telephone_number": "856-547-4000",
            "fax_number": "856-547-1118"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "GOLDBERG",
        "first_name": "KENNETH",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-08-06",
        "last_updated": "2014-08-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "2258",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Haddon Township, NJ

Sources for this page

Verify at the official NPI Registry.