Provider Demographics
NPI:1992785927
Name:GOLDMAN, JOAN ESTHER (PHD)
Entity type:Individual
Prefix:
First Name:JOAN
Middle Name:ESTHER
Last Name:GOLDMAN
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 1:505 MIDDLESEX TPKE
Mailing Address - Street 2:#3
Mailing Address - City:BILLERICA
Mailing Address - State:MA
Mailing Address - Zip Code:01821
Mailing Address - Country:US
Mailing Address - Phone:978-663-7077
Mailing Address - Fax:617-527-2199
Practice Address - Street 1:505 MIDDLESEX TPKE
Practice Address - Street 2:#3
Practice Address - City:BILLERICA
Practice Address - State:MA
Practice Address - Zip Code:01821
Practice Address - Country:US
Practice Address - Phone:978-663-7077
Practice Address - Fax:617-527-2199
Is Sole Proprietor?:No
Enumeration Date:2006-01-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3842103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW03814OtherBC BS INSURANCE
MA708660OtherTUFTS INSURANCE
MAS003417OtherCHAMPUS
MAS003417OtherTRICARE
MA0520063Medicaid
MA708660OtherTUFTS INSURANCE
W63814Medicare ID - Type Unspecified