Provider Demographics
NPI:1598835126
Name:GOLD, EVA KAY (PSY D)
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:KAY
Last Name:GOLD
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:DR
Other - First Name:ELAINE
Other - Middle Name:KAY
Other - Last Name:BRESHGOLD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:757 SE 34TH AVE
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97214-3177
Mailing Address - Country:US
Mailing Address - Phone:503-230-0900
Mailing Address - Fax:
Practice Address - Street 1:757 SE 34TH AVE
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-3177
Practice Address - Country:US
Practice Address - Phone:503-230-0900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR839103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist