Provider Demographics
NPI:1295012961
Name:GOLDENTHAL, PETER (PHD)
Entity Type:Individual
Prefix:DR
First Name:PETER
Middle Name:
Last Name:GOLDENTHAL
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:PETER
Other - Middle Name:
Other - Last Name:GOLDENTHAL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:109 FORREST AVE
Mailing Address - Street 2:
Mailing Address - City:NARBERTH
Mailing Address - State:PA
Mailing Address - Zip Code:19072-2295
Mailing Address - Country:US
Mailing Address - Phone:610-660-8400
Mailing Address - Fax:
Practice Address - Street 1:109 FORREST AVE
Practice Address - Street 2:
Practice Address - City:NARBERTH
Practice Address - State:PA
Practice Address - Zip Code:19072-2295
Practice Address - Country:US
Practice Address - Phone:610-660-8400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-09
Last Update Date:2011-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPA 4180103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist