Provider Demographics
NPI:1699380816
Name:GOLDSMITH PSYCHOLOGY, INC
Entity Type:Organization
Organization Name:GOLDSMITH PSYCHOLOGY, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDSMITH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:909-521-8651
Mailing Address - Street 1:101 N INDIAN HILL BLVD STE C2-202
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-4670
Mailing Address - Country:US
Mailing Address - Phone:909-521-8651
Mailing Address - Fax:
Practice Address - Street 1:101 N INDIAN HILL BLVD STE C2-202
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-4670
Practice Address - Country:US
Practice Address - Phone:909-521-8651
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty