Provider Demographics
NPI:1538327739
Name:GOLDSMITH, JOSEPH PATRICK (EDD)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:PATRICK
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 669
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:SC
Mailing Address - Zip Code:29721-0669
Mailing Address - Country:US
Mailing Address - Phone:803-283-4004
Mailing Address - Fax:803-283-4004
Practice Address - Street 1:114 WILLIAMS ST
Practice Address - Street 2:CONNELLY BUILDING, SUITE 104
Practice Address - City:LANCASTER
Practice Address - State:SC
Practice Address - Zip Code:29720-2483
Practice Address - Country:US
Practice Address - Phone:803-283-4004
Practice Address - Fax:803-283-4004
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-26
Last Update Date:2008-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC262103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCPS0040Medicaid
SCPS0040Medicaid