Provider Demographics
NPI:1376815530
Name:GOLDMAN, DAVID (CD (PALS))
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:M
Credentials:CD (PALS)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 CORNWALL AVE STE 1051
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-3659
Mailing Address - Country:US
Mailing Address - Phone:360-303-6918
Mailing Address - Fax:
Practice Address - Street 1:1901 CORNWALL AVE STE 1051
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-3659
Practice Address - Country:US
Practice Address - Phone:360-303-6918
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-03
Last Update Date:2023-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61383617101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health