Provider Demographics
NPI:1164662532
Name:GOLDSTEIN, MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:GOLDSTEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1414 AVENUE P
Mailing Address - Street 2:SUITE 8
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1110
Mailing Address - Country:US
Mailing Address - Phone:718-375-8400
Mailing Address - Fax:718-375-8401
Practice Address - Street 1:1414 AVENUE P
Practice Address - Street 2:SUITE 8
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1110
Practice Address - Country:US
Practice Address - Phone:718-375-8400
Practice Address - Fax:718-375-8401
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017874103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist