Provider Demographics
NPI:1083045249
Name:GOLMAN, STACY (PSYD)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:
Last Name:GOLMAN
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 1:1 UNIVERSITY BLVD
Mailing Address - Street 2:UNIVERSITY OF MISSOURI - ST. LOUIS
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63121-4400
Mailing Address - Country:US
Mailing Address - Phone:314-516-5824
Mailing Address - Fax:314-516-5347
Practice Address - Street 1:1 UNIVERSITY BLVD
Practice Address - Street 2:UNIVERSITY OF MISSOURI - ST. LOUIS
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63121-4400
Practice Address - Country:US
Practice Address - Phone:314-516-5824
Practice Address - Fax:314-516-5347
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2013-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2013040102103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical