Provider Demographics
NPI:1053652784
Name:GOLD, DYLANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:DYLANN
Middle Name:
Last Name:GOLD
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 1:40 VILLAGE GREEN #637
Mailing Address - Street 2:
Mailing Address - City:BEDFORD
Mailing Address - State:NY
Mailing Address - Zip Code:10506-7935
Mailing Address - Country:US
Mailing Address - Phone:914-236-0457
Mailing Address - Fax:
Practice Address - Street 1:135 MADISON AVE # 1409
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6712
Practice Address - Country:US
Practice Address - Phone:914-236-0457
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-05
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY022227103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical