Provider Demographics
NPI:1427522333
Name:GOLDMAN-HENLEY, RAVID
Entity type:Individual
Prefix:
First Name:RAVID
Middle Name:
Last Name:GOLDMAN-HENLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 WINTHROP RD
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02445-4573
Mailing Address - Country:US
Mailing Address - Phone:617-835-2965
Mailing Address - Fax:
Practice Address - Street 1:20 WINTHROP RD
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02445-4573
Practice Address - Country:US
Practice Address - Phone:617-835-2965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-01-14
Last Update Date:2019-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program