Provider Demographics
NPI:1093986184
Name:GOLDMAN, AUDREY (EDD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13035 N. 48TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85254-3536
Mailing Address - Country:US
Mailing Address - Phone:602-762-7117
Mailing Address - Fax:
Practice Address - Street 1:1817 NORTH 7TH ST
Practice Address - Street 2:PHOENIX ELEMENTARY SCHOOL DISTRICT #1
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006
Practice Address - Country:US
Practice Address - Phone:602-257-3755
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist