Provider Demographics
NPI:1154488633
Name:GOLDSTEIN, ERIC (PHD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:
Last Name:GOLDSTEIN
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 1:5975 SUNSET DR
Mailing Address - Street 2:SUITE 803
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33143-5174
Mailing Address - Country:US
Mailing Address - Phone:305-662-5299
Mailing Address - Fax:
Practice Address - Street 1:5975 SUNSET DR
Practice Address - Street 2:SUITE 803
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33143-5174
Practice Address - Country:US
Practice Address - Phone:305-662-5299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0003730103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75968Medicare PIN