Provider Demographics
NPI:1427338680
Name:GOAL PSYCHIATRIC ASSOCIATES, LLC
Entity type:Organization
Organization Name:GOAL PSYCHIATRIC ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-766-4702
Mailing Address - Street 1:1040 WESTON RD
Mailing Address - Street 2:SUITE 210
Mailing Address - City:WESTON
Mailing Address - State:FL
Mailing Address - Zip Code:33326-1912
Mailing Address - Country:US
Mailing Address - Phone:954-766-4702
Mailing Address - Fax:954-766-4907
Practice Address - Street 1:1040 WESTON RD
Practice Address - Street 2:SUITE 210
Practice Address - City:WESTON
Practice Address - State:FL
Practice Address - Zip Code:33326-1912
Practice Address - Country:US
Practice Address - Phone:954-766-4702
Practice Address - Fax:954-766-4907
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-19
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME977412084P0800X, 2084P0804X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0804XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyChild & Adolescent PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL001441900Medicaid
FLGM814AOtherGROUP MEDICARE PTAN
FLGM814AOtherGROUP MEDICARE PTAN