Provider Demographics
NPI:1548561053
Name:KEITH GOLIN PHD LLC
Entity Type:Organization
Organization Name:KEITH GOLIN PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:888-284-2034
Mailing Address - Street 1:18 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1432
Mailing Address - Country:US
Mailing Address - Phone:516-330-0314
Mailing Address - Fax:302-422-8697
Practice Address - Street 1:18 ASPEN DR
Practice Address - Street 2:
Practice Address - City:LIVINGSTON
Practice Address - State:NJ
Practice Address - Zip Code:07039
Practice Address - Country:US
Practice Address - Phone:516-330-0314
Practice Address - Fax:302-422-8697
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-15
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100409900103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1487660213OtherSECONDARY INSURANCE COMPANIES
NJ0221830Medicaid
NJDH0611OtherRAILROAD MCB
NJ160908Medicare PIN