Provider Demographics
NPI:1093878688
Name:GOLDFARB, DANIEL A (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:A
Last Name:GOLDFARB
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 HOLLY BERRY CT
Mailing Address - Street 2:
Mailing Address - City:WADING RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:11792-2157
Mailing Address - Country:US
Mailing Address - Phone:631-929-5782
Mailing Address - Fax:631-724-5546
Practice Address - Street 1:750 VETERANS HWY
Practice Address - Street 2:
Practice Address - City:HAUPPAUGE
Practice Address - State:NY
Practice Address - Zip Code:11788-2943
Practice Address - Country:US
Practice Address - Phone:631-724-5522
Practice Address - Fax:631-724-5546
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8390103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical