Provider Demographics
NPI:1114084902
Name:GOLDMAN, DEBRA SUSAN (MS, CCCSLP)
Entity Type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:SUSAN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:MS, CCCSLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 LINCOLN CIR. E.
Mailing Address - Street 2:
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810
Mailing Address - Country:US
Mailing Address - Phone:978-470-1331
Mailing Address - Fax:
Practice Address - Street 1:11 CHESTNUT ST STE 7
Practice Address - Street 2:
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3724
Practice Address - Country:US
Practice Address - Phone:978-296-4486
Practice Address - Fax:978-296-4448
Is Sole Proprietor?:No
Enumeration Date:2007-01-02
Last Update Date:2019-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3859235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MASP 0038OtherBCBS