Provider Demographics
NPI:1427592971
Name:GOLDENBACK, ROBIN
Entity type:Individual
Prefix:
First Name:ROBIN
Middle Name:
Last Name:GOLDENBACK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109-36 204TH ST.
Mailing Address - Street 2:P. 233@ 827
Mailing Address - City:HOLLIS
Mailing Address - State:NY
Mailing Address - Zip Code:11412
Mailing Address - Country:US
Mailing Address - Phone:718-465-8310
Mailing Address - Fax:718-465-3939
Practice Address - Street 1:10936 204TH ST
Practice Address - Street 2:
Practice Address - City:SAINT ALBANS
Practice Address - State:NY
Practice Address - Zip Code:11412-1326
Practice Address - Country:US
Practice Address - Phone:718-465-8310
Practice Address - Fax:718-465-3939
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-16
Last Update Date:2016-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003894-1235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist