Provider Demographics
NPI:1679550172
Name:GOLDMAN, DAVIDA Z (PHD, LP)
Entity Type:Individual
Prefix:
First Name:DAVIDA
Middle Name:Z
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PHD, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 AVONDALE ST
Mailing Address - Street 2:
Mailing Address - City:MINNETONKA
Mailing Address - State:MN
Mailing Address - Zip Code:55345-1805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7200 FRANCE AVE S
Practice Address - Street 2:SUITE 128
Practice Address - City:EDINA
Practice Address - State:MN
Practice Address - Zip Code:55435-4300
Practice Address - Country:US
Practice Address - Phone:952-831-7400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP4036103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN61-90675OtherMEDICA
MN116883OtherHEALTHPARTNERS
MN336G4GOOtherBLUE CROSS BLUE SHIELD