Provider Demographics
NPI:1821503236
Name:GOLDSMITH, THEODORE JAMES (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:JAMES
Last Name:GOLDSMITH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 WESTWOOD PLAZA, SUITE 2437
Mailing Address - Street 2:BOX 951556
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90095-1556
Mailing Address - Country:US
Mailing Address - Phone:310-825-0768
Mailing Address - Fax:
Practice Address - Street 1:1031 W 34TH ST FL 3
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089
Practice Address - Country:US
Practice Address - Phone:213-740-7711
Practice Address - Fax:213-740-6815
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-07
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY29425103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty