Provider Demographics
NPI:1659725182
Name:GOLDIN, DONNA (MED, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:GOLDIN
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:123 MASSASOIT AVE
Mailing Address - Street 2:
Mailing Address - City:CRANSTON
Mailing Address - State:RI
Mailing Address - Zip Code:02905-3704
Mailing Address - Country:US
Mailing Address - Phone:401-680-0566
Mailing Address - Fax:
Practice Address - Street 1:123 MASSASOIT AVE
Practice Address - Street 2:
Practice Address - City:CRANSTON
Practice Address - State:RI
Practice Address - Zip Code:02905-3704
Practice Address - Country:US
Practice Address - Phone:401-680-0566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-21
Last Update Date:2016-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI00058103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst