Provider Demographics
NPI:1235286162
Name:GOLDEN, BETH R (PHD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:R
Last Name:GOLDEN
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 1:65 E ELIZABETH AVE
Mailing Address - Street 2:SUITE 608
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-6518
Mailing Address - Country:US
Mailing Address - Phone:908-310-4421
Mailing Address - Fax:
Practice Address - Street 1:65 E ELIZABETH AVE
Practice Address - Street 2:SUITE 608
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18018-6518
Practice Address - Country:US
Practice Address - Phone:908-310-4421
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-04
Last Update Date:2014-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005507L103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS0055507LOtherPSYCHOLOGIST LICENSE