Provider Demographics
NPI:1255846093
Name:GOLDMAN, KIM (PSYD)
Entity Type:Individual
Prefix:DR
First Name:KIM
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1450
Mailing Address - Street 2:
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95001-1450
Mailing Address - Country:US
Mailing Address - Phone:714-478-6412
Mailing Address - Fax:
Practice Address - Street 1:171 WINGFOOT WAY
Practice Address - Street 2:
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-5429
Practice Address - Country:US
Practice Address - Phone:714-478-6412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-01
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17877103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical