Provider Demographics
NPI:1689610875
Name:GOLIN, KEITH (PHD)
Entity Type:Individual
Prefix:
First Name:KEITH
Middle Name:
Last Name:GOLIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 ASPEN DR
Mailing Address - Street 2:
Mailing Address - City:LIVINGSTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07039-1432
Mailing Address - Country:US
Mailing Address - Phone:888-284-2034
Mailing Address - Fax:973-992-4639
Practice Address - Street 1:659 EAGLE ROCK AVE
Practice Address - Street 2:STE 4
Practice Address - City:WEST ORANGE
Practice Address - State:NJ
Practice Address - Zip Code:07052-2138
Practice Address - Country:US
Practice Address - Phone:888-284-2034
Practice Address - Fax:973-992-4639
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2021-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI0040990103TC0700X
NJ35S100409900103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1487660213OtherPRIMARY INSURANCE CO
NJ1548561053OtherSECONDARY INSURANCE COMPANIES