Provider Demographics
NPI:1528541547
Name:GOLDPSYCHOLOGY
Entity Type:Organization
Organization Name:GOLDPSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JACK
Authorized Official - Middle Name:DEEMS
Authorized Official - Last Name:GOLD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:352-502-3525
Mailing Address - Street 1:15151 S US HIGHWAY 441 STE 300
Mailing Address - Street 2:
Mailing Address - City:SUMMERFIELD
Mailing Address - State:FL
Mailing Address - Zip Code:34491-4482
Mailing Address - Country:US
Mailing Address - Phone:352-502-3525
Mailing Address - Fax:352-732-7333
Practice Address - Street 1:15151 S US HIGHWAY 441 STE 300
Practice Address - Street 2:
Practice Address - City:SUMMERFIELD
Practice Address - State:FL
Practice Address - Zip Code:34491-4482
Practice Address - Country:US
Practice Address - Phone:352-502-3525
Practice Address - Fax:352-732-7333
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-14
Last Update Date:2018-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
90100OtherBCBS
1831141654OtherUBH
682469OtherBEACON HEALTH OPTIONS
1831141654OtherTRICARE
1831141654OtherAETNA