Provider Demographics
NPI:1396013132
Name:GOLDOV, NANCY BETH (PSYD, BC-DMT)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:BETH
Last Name:GOLDOV
Suffix:
Gender:F
Credentials:PSYD, BC-DMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5802 17TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-2512
Mailing Address - Country:US
Mailing Address - Phone:206-979-9743
Mailing Address - Fax:
Practice Address - Street 1:1314 NE 43RD ST STE 209
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5832
Practice Address - Country:US
Practice Address - Phone:206-979-9743
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPY-60246450103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical