Provider Demographics
NPI:1003405564
Name:GOLDBERG, CHAIM B (BCBA)
Entity Type:Individual
Prefix:
First Name:CHAIM
Middle Name:B
Last Name:GOLDBERG
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 OAK GLEN RD
Mailing Address - Street 2:
Mailing Address - City:MONSEY
Mailing Address - State:NY
Mailing Address - Zip Code:10952-3646
Mailing Address - Country:US
Mailing Address - Phone:845-422-1958
Mailing Address - Fax:
Practice Address - Street 1:3 OAK GLEN RD
Practice Address - Street 2:
Practice Address - City:MONSEY
Practice Address - State:NY
Practice Address - Zip Code:10952-3646
Practice Address - Country:US
Practice Address - Phone:845-422-1958
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst