Provider Demographics
NPI:1467403725
Name:GOLD, DIANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:
Last Name:GOLD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MRS
Other - First Name:DIANE
Other - Middle Name:MANN
Other - Last Name:GOLD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:1 ETON RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067
Mailing Address - Country:US
Mailing Address - Phone:215-428-3620
Mailing Address - Fax:215-428-0552
Practice Address - Street 1:1 ETON RD
Practice Address - Street 2:
Practice Address - City:YARDLEY
Practice Address - State:PA
Practice Address - Zip Code:19067
Practice Address - Country:US
Practice Address - Phone:215-428-3620
Practice Address - Fax:215-428-0552
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-12
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002738L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
22642400OtherMAGELLAN
001664804OtherBCBS PERSONAL CHOICE
R05903Medicare UPIN
22642400OtherMAGELLAN