Provider Demographics
NPI:1083641203
Name:GOLD, JULIE (PMHNP, NM)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:
Last Name:GOLD
Suffix:
Gender:
Credentials:PMHNP, NM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:529 CLINTON ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11231-3300
Mailing Address - Country:US
Mailing Address - Phone:718-926-5522
Mailing Address - Fax:
Practice Address - Street 1:529 CLINTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11231-3300
Practice Address - Country:US
Practice Address - Phone:718-926-5522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF000657176B00000X
NY402968363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1779771Medicaid
S49974Medicare UPIN