Provider Demographics
NPI:1992924807
Name:GOLDMAN, ROBYN SUE (EDD)
Entity type:Individual
Prefix:DR
First Name:ROBYN
Middle Name:SUE
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2400 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BRIDGEPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06606-5323
Mailing Address - Country:US
Mailing Address - Phone:203-362-3908
Mailing Address - Fax:203-362-2463
Practice Address - Street 1:2400 MAIN ST
Practice Address - Street 2:
Practice Address - City:BRIDGEPORT
Practice Address - State:CT
Practice Address - Zip Code:06606-5323
Practice Address - Country:US
Practice Address - Phone:203-362-3908
Practice Address - Fax:203-362-2463
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2010-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000151101YA0400X
CT003013103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004039251Medicaid
CT004039251Medicaid