Provider Demographics
NPI:1992899496
Name:GOLDBERG, CARYN (PHD)
Entity type:Individual
Prefix:DR
First Name:CARYN
Middle Name:
Last Name:GOLDBERG
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 1:5200 S ULSTER ST APT 1613
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD VILLAGE
Mailing Address - State:CO
Mailing Address - Zip Code:80111-2866
Mailing Address - Country:US
Mailing Address - Phone:303-792-3414
Mailing Address - Fax:
Practice Address - Street 1:9980 PARK MEADOWS DR
Practice Address - Street 2:107
Practice Address - City:LONE TREE
Practice Address - State:CO
Practice Address - Zip Code:80124-6739
Practice Address - Country:US
Practice Address - Phone:303-792-3414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2013-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO907103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO07009079Medicaid
CO841148770OtherPSYCHOLOGIST
CO07009079Medicaid