Provider Demographics
NPI:1215291158
Name:GOLDENBERG-BIVENS, RAYCHUL (PSYD)
Entity type:Individual
Prefix:DR
First Name:RAYCHUL
Middle Name:
Last Name:GOLDENBERG-BIVENS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WEST WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434
Mailing Address - Country:US
Mailing Address - Phone:757-925-0222
Mailing Address - Fax:757-925-1414
Practice Address - Street 1:154 WEST WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434
Practice Address - Country:US
Practice Address - Phone:757-925-0222
Practice Address - Fax:757-925-1414
Is Sole Proprietor?:No
Enumeration Date:2012-06-26
Last Update Date:2012-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810004150103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical