Provider Demographics
NPI:1710069109
Name:GOLDMUNTZ, PENELOPE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:PENELOPE
Middle Name:
Last Name:GOLDMUNTZ
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 LIBBEY INDUSTRIAL PKWY
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:WEYMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02189-3101
Mailing Address - Country:US
Mailing Address - Phone:781-682-1060
Mailing Address - Fax:781-682-1061
Practice Address - Street 1:169 LIBBEY INDUSTRIAL PKWY
Practice Address - Street 2:2ND FLOOR
Practice Address - City:WEYMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02189-3101
Practice Address - Country:US
Practice Address - Phone:781-682-1060
Practice Address - Fax:781-682-1061
Is Sole Proprietor?:No
Enumeration Date:2006-10-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA6073103TC0700X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04877OtherBCBC PROVIDER NUMBER
MD6100648OtherEVERCARE PROVIDER NUMBER
MAW04877OtherBCBC PROVIDER NUMBER