Provider Demographics
NPI:1235568825
Name:GOSHEN PSYCHOLOGY, PLLC.
Entity Type:Organization
Organization Name:GOSHEN PSYCHOLOGY, PLLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:KLINGER-ROSENFELD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:845-294-4241
Mailing Address - Street 1:305 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:NY
Mailing Address - Zip Code:10924-1638
Mailing Address - Country:US
Mailing Address - Phone:845-294-4241
Mailing Address - Fax:845-294-4241
Practice Address - Street 1:305 MAIN ST
Practice Address - Street 2:
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-1638
Practice Address - Country:US
Practice Address - Phone:845-294-4241
Practice Address - Fax:845-294-4241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-05
Last Update Date:2013-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY013072NYS103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty