Provider Demographics
NPI:1790777639
Name:GOLDMAN, ARLENE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ARLENE
Middle Name:
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 S 17TH ST
Mailing Address - Street 2:SUITE 2900
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-6231
Mailing Address - Country:US
Mailing Address - Phone:215-545-7014
Mailing Address - Fax:215-545-7011
Practice Address - Street 1:255 S 17TH ST
Practice Address - Street 2:SUITE 2900
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6231
Practice Address - Country:US
Practice Address - Phone:215-545-7014
Practice Address - Fax:215-545-7011
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-17
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS 00222800 L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAGO 030762Medicare PIN