Provider Demographics
NPI:1528212610
Name:GOLDSTEIN, ADINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:ADINA
Middle Name:
Last Name:GOLDSTEIN
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 1:123 HARBOR DR
Mailing Address - Street 2:#706
Mailing Address - City:STAMFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06902-7451
Mailing Address - Country:US
Mailing Address - Phone:203-356-0035
Mailing Address - Fax:
Practice Address - Street 1:123 HARBOR DR
Practice Address - Street 2:#706
Practice Address - City:STAMFORD
Practice Address - State:CT
Practice Address - Zip Code:06902-7451
Practice Address - Country:US
Practice Address - Phone:203-356-0035
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-16
Last Update Date:2008-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0048431041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical