Provider Demographics
NPI:1891919437
Name:GOLDSTEIN ELBOGEN, ALLYSON (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ALLYSON
Middle Name:
Last Name:GOLDSTEIN ELBOGEN
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COUNTY RD
Mailing Address - Street 2:#7
Mailing Address - City:CRESSKILL
Mailing Address - State:NJ
Mailing Address - Zip Code:07626
Mailing Address - Country:US
Mailing Address - Phone:201-286-4985
Mailing Address - Fax:
Practice Address - Street 1:155 COUNTY RD
Practice Address - Street 2:#7
Practice Address - City:CRESSKILL
Practice Address - State:NJ
Practice Address - Zip Code:07626-2200
Practice Address - Country:US
Practice Address - Phone:201-286-4985
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00437900103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical