Provider Demographics
NPI:1073006003
Name:GOLDBERG, CAROLE TAYLOR (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLE
Middle Name:TAYLOR
Last Name:GOLDBERG
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 1:62 TRUMBULL ST
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06510-1022
Mailing Address - Country:US
Mailing Address - Phone:203-376-7676
Mailing Address - Fax:203-699-8900
Practice Address - Street 1:62 TRUMBULL ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06510-1022
Practice Address - Country:US
Practice Address - Phone:203-376-7676
Practice Address - Fax:203-699-8900
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-13
Last Update Date:2018-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical