Provider Demographics
NPI:1992802938
Name:GOLDFARB, NORMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5225 N IRONWOOD LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:WI
Mailing Address - Zip Code:53217-4909
Mailing Address - Country:US
Mailing Address - Phone:414-962-9156
Mailing Address - Fax:414-962-4356
Practice Address - Street 1:5225 N IRONWOOD LN STE 102
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:WI
Practice Address - Zip Code:53217-4909
Practice Address - Country:US
Practice Address - Phone:414-962-9156
Practice Address - Fax:414-962-4356
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2010-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI684-057103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI39074800Medicaid
WI39074800Medicaid