Provider Demographics
NPI:1336479708
Name:GOLDMAN, SARI (PSYD)
Entity Type:Individual
Prefix:
First Name:SARI
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 1:1200 PINEWOOD RD
Mailing Address - Street 2:
Mailing Address - City:VILLANOVA
Mailing Address - State:PA
Mailing Address - Zip Code:19085-2135
Mailing Address - Country:US
Mailing Address - Phone:267-515-2845
Mailing Address - Fax:
Practice Address - Street 1:1200 PINEWOOD RD
Practice Address - Street 2:
Practice Address - City:VILLANOVA
Practice Address - State:PA
Practice Address - Zip Code:19085-2135
Practice Address - Country:US
Practice Address - Phone:267-515-2845
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-01-07
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW017161041C0700X
PAPS018002103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical