Provider Demographics
NPI:1669507950
Name:GOLDSTEIN, JAMES SAMUEL I (LMFT)
Entity Type:Individual
Prefix:MR
First Name:JAMES
Middle Name:SAMUEL
Last Name:GOLDSTEIN
Suffix:I
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5504 S LEBANON RD
Mailing Address - Street 2:
Mailing Address - City:EARLVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13332-3146
Mailing Address - Country:US
Mailing Address - Phone:315-691-3311
Mailing Address - Fax:315-724-5323
Practice Address - Street 1:1643 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-4733
Practice Address - Country:US
Practice Address - Phone:315-724-5173
Practice Address - Fax:315-724-5323
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000003106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY040426031795OtherFIDELLIS
NY562927OtherVALUE OPTIONS