Provider Demographics
NPI:1821224031
Name:GOLDSCHLAG, EVE LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:EVE
Middle Name:LYNN
Last Name:GOLDSCHLAG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:EVE
Other - Middle Name:LYNN
Other - Last Name:GOLDSCHLAG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:75 MANOR LN
Mailing Address - Street 2:
Mailing Address - City:WOODMERE
Mailing Address - State:NY
Mailing Address - Zip Code:11598-2217
Mailing Address - Country:US
Mailing Address - Phone:516-232-6655
Mailing Address - Fax:
Practice Address - Street 1:75 MANOR LN
Practice Address - Street 2:
Practice Address - City:WOODMERE
Practice Address - State:NY
Practice Address - Zip Code:11598-2217
Practice Address - Country:US
Practice Address - Phone:516-232-6655
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-02
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY018002103T00000X, 103TC0700X, 103TC2200X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool