Provider Demographics
NPI:1568689313
Name:GOLOB, RISA S (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RISA
Middle Name:S
Last Name:GOLOB
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WEDGEWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NORTH BRUNSWICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08902-1328
Mailing Address - Country:US
Mailing Address - Phone:732-846-7680
Mailing Address - Fax:732-846-9243
Practice Address - Street 1:1 WEDGEWOOD DR
Practice Address - Street 2:
Practice Address - City:NORTH BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08902-1328
Practice Address - Country:US
Practice Address - Phone:732-846-7680
Practice Address - Fax:732-846-9243
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100136300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ601082Medicare ID - Type UnspecifiedMEDICARE ID NO.