Provider Demographics
NPI:1891820395
Name:GOLD, DEBRA RENA (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:RENA
Last Name:GOLD
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 1:48 BURD STREET
Mailing Address - Street 2:SUITE 205B
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960
Mailing Address - Country:US
Mailing Address - Phone:845-353-5569
Mailing Address - Fax:
Practice Address - Street 1:48 BURD STREET
Practice Address - Street 2:SUITE 205B
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960
Practice Address - Country:US
Practice Address - Phone:845-353-5569
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0093421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY144783OtherVALUE OPTIONS
NY6802386OtherGHI