Provider Demographics
NPI:1033617220
Name:GOLDMAN, LAURA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 SE OCEAN BLVD STE 250F
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34994-3501
Mailing Address - Country:US
Mailing Address - Phone:772-242-9950
Mailing Address - Fax:542-061-9787
Practice Address - Street 1:900 SE OCEAN BLVD STE 250F
Practice Address - Street 2:
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-3501
Practice Address - Country:US
Practice Address - Phone:772-242-9950
Practice Address - Fax:542-061-9787
Is Sole Proprietor?:No
Enumeration Date:2018-01-23
Last Update Date:2022-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10078103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical