Provider Demographics
NPI:1346688082
Name:JURAREL, GOLDIE M (MSE)
Entity Type:Individual
Prefix:MRS
First Name:GOLDIE
Middle Name:M
Last Name:JURAREL
Suffix:
Gender:F
Credentials:MSE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LAUREL PARK ROAD
Mailing Address - Street 2:APT H5
Mailing Address - City:FALLSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12733
Mailing Address - Country:US
Mailing Address - Phone:845-423-8970
Mailing Address - Fax:
Practice Address - Street 1:61 LAUREL PARK ROAD
Practice Address - Street 2:APT H5
Practice Address - City:FALLSBURY
Practice Address - State:NY
Practice Address - Zip Code:12733
Practice Address - Country:US
Practice Address - Phone:845-423-8970
Practice Address - Fax:845-434-5696
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY217528150103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYET881535Medicaid