Provider Demographics
NPI:1083225387
Name:GOLDEN, EITAN P
Entity Type:Individual
Prefix:
First Name:EITAN
Middle Name:P
Last Name:GOLDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 WINSLOW RD
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-1113
Mailing Address - Country:US
Mailing Address - Phone:781-363-1042
Mailing Address - Fax:
Practice Address - Street 1:24 WINSLOW RD
Practice Address - Street 2:
Practice Address - City:SHARON
Practice Address - State:MA
Practice Address - Zip Code:02067-1113
Practice Address - Country:US
Practice Address - Phone:781-363-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-11
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst