Provider Demographics
NPI:1588983084
Name:GOLDSON, HORACE SOMMERVILLE (BS)
Entity type:Individual
Prefix:MR
First Name:HORACE
Middle Name:SOMMERVILLE
Last Name:GOLDSON
Suffix:
Gender:M
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1034 GROVE PARK CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33436-9436
Mailing Address - Country:US
Mailing Address - Phone:561-503-1139
Mailing Address - Fax:561-712-8070
Practice Address - Street 1:1034 GROVE PARK CIR
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33436-9436
Practice Address - Country:US
Practice Address - Phone:561-503-1139
Practice Address - Fax:561-712-8070
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHXZ440139708313OtherBLUECROSS BLUE SHIELD