Provider Demographics
NPI:1851648943
Name:GOLDSMITH, ANTONIO LAMAR JR
Entity Type:Individual
Prefix:MR
First Name:ANTONIO
Middle Name:LAMAR
Last Name:GOLDSMITH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 N MERIDIAN AVE STE 408
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73107-5774
Mailing Address - Country:US
Mailing Address - Phone:405-365-5193
Mailing Address - Fax:
Practice Address - Street 1:500 N MERIDIAN AVE STE 408
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73107-5774
Practice Address - Country:US
Practice Address - Phone:405-365-5193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst