Provider Demographics
NPI:1518237403
Name:GOLDBERG, JUDITH LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JUDITH
Middle Name:LOUISE
Last Name:GOLDBERG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MARIANNA DR
Mailing Address - Street 2:
Mailing Address - City:HASTINGS ON HUDSON
Mailing Address - State:NY
Mailing Address - Zip Code:10706-4020
Mailing Address - Country:US
Mailing Address - Phone:914-478-7202
Mailing Address - Fax:
Practice Address - Street 1:15 W 75TH ST
Practice Address - Street 2:APT 1B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-2060
Practice Address - Country:US
Practice Address - Phone:914-478-7202
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-09
Last Update Date:2012-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010302-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical