Provider Demographics
NPI:1063762037
Name:GOLDSMITH, CAROL MARIE
Entity type:Individual
Prefix:MS
First Name:CAROL
Middle Name:MARIE
Last Name:GOLDSMITH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 N BOOMER RD
Mailing Address - Street 2:APT H 16
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74075-3402
Mailing Address - Country:US
Mailing Address - Phone:405-372-0115
Mailing Address - Fax:
Practice Address - Street 1:1815 N BOOMER RD
Practice Address - Street 2:APT H 16
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74075-3402
Practice Address - Country:US
Practice Address - Phone:405-372-0115
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health