Provider Demographics
NPI:1568868396
Name:GOLDSMITH, STEPHANIE (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:
Last Name:GOLDSMITH
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 1:101 N INDIAN HILL BLVD
Mailing Address - Street 2:STE C2-202
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4666
Mailing Address - Country:US
Mailing Address - Phone:909-521-8651
Mailing Address - Fax:
Practice Address - Street 1:101 N INDIAN HILL BLVD
Practice Address - Street 2:STE C2-202
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4666
Practice Address - Country:US
Practice Address - Phone:909-521-8651
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-05
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29246103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical