Provider Demographics
NPI:1508526781
Name:GOLDSTEIN, STEVEN JOEL
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JOEL
Last Name:GOLDSTEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:35 TUTHILL POINT RD
Mailing Address - Street 2:
Mailing Address - City:EAST MORICHES
Mailing Address - State:NY
Mailing Address - Zip Code:11940-1216
Mailing Address - Country:US
Mailing Address - Phone:914-419-2328
Mailing Address - Fax:
Practice Address - Street 1:35 TUTHILL POINT RD
Practice Address - Street 2:
Practice Address - City:EAST MORICHES
Practice Address - State:NY
Practice Address - Zip Code:11940-1216
Practice Address - Country:US
Practice Address - Phone:914-419-2328
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-29
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0050021103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty