Provider Demographics
NPI:1194817650
Name:GOLDSTEIN, ELIZABETH SARAH (PHD)
Entity Type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:SARAH
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 1:3 MAIN ST
Mailing Address - Street 2:STE 216
Mailing Address - City:BURLINGTON
Mailing Address - State:VT
Mailing Address - Zip Code:05401-5216
Mailing Address - Country:US
Mailing Address - Phone:802-651-7502
Mailing Address - Fax:802-651-1234
Practice Address - Street 1:3 MAIN ST
Practice Address - Street 2:STE 216
Practice Address - City:BURLINGTON
Practice Address - State:VT
Practice Address - Zip Code:05401-5216
Practice Address - Country:US
Practice Address - Phone:802-651-7502
Practice Address - Fax:802-651-1234
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-29
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT0480000880103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical