Provider Demographics
NPI:1275362600
Name:GOLDMAN PSYCHOLOGICAL SERVICES
Entity type:Organization
Organization Name:GOLDMAN PSYCHOLOGICAL SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOLDMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:314-884-8075
Mailing Address - Street 1:7110 OAKLAND AVE STE 105
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HEIGHTS
Mailing Address - State:MO
Mailing Address - Zip Code:63117-1870
Mailing Address - Country:US
Mailing Address - Phone:314-884-8075
Mailing Address - Fax:314-227-9327
Practice Address - Street 1:7110 OAKLAND AVE STE 105
Practice Address - Street 2:
Practice Address - City:RICHMOND HEIGHTS
Practice Address - State:MO
Practice Address - Zip Code:63117-1870
Practice Address - Country:US
Practice Address - Phone:314-884-8075
Practice Address - Fax:314-227-9327
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-01
Last Update Date:2024-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty