Provider Demographics
NPI:1285959841
Name:GOFBERG, ROBIN (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBIN
Middle Name:
Last Name:GOFBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 N BROAD ST
Mailing Address - Street 2:SUITE 301
Mailing Address - City:LANCASTER
Mailing Address - State:OH
Mailing Address - Zip Code:43130-3738
Mailing Address - Country:US
Mailing Address - Phone:740-243-0247
Mailing Address - Fax:
Practice Address - Street 1:109 N BROAD ST
Practice Address - Street 2:SUITE 301
Practice Address - City:LANCASTER
Practice Address - State:OH
Practice Address - Zip Code:43130-3738
Practice Address - Country:US
Practice Address - Phone:740-243-0247
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-07
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3447103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist