Provider Demographics
NPI:1124382064
Name:GOLDSCHMIDT, DENISE BRENDA
Entity Type:Individual
Prefix:MRS
First Name:DENISE
Middle Name:BRENDA
Last Name:GOLDSCHMIDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PERTH LN
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-5808
Mailing Address - Country:US
Mailing Address - Phone:845-634-1267
Mailing Address - Fax:
Practice Address - Street 1:5 PERTH LN
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-5808
Practice Address - Country:US
Practice Address - Phone:845-634-1267
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-26
Last Update Date:2012-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY2106584252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY197356081OtherPUBLIC SCHOOL TEACHER CERRTIFICATE