Provider Demographics
NPI:1013131713
Name:GOLDMAN, SHOSHANA M
Entity type:Individual
Prefix:DR
First Name:SHOSHANA
Middle Name:M
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:451 W END AVE
Mailing Address - Street 2:2E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-5347
Mailing Address - Country:US
Mailing Address - Phone:212-362-3071
Mailing Address - Fax:212-769-1916
Practice Address - Street 1:451 W END AVE
Practice Address - Street 2:2E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-5347
Practice Address - Country:US
Practice Address - Phone:212-362-3071
Practice Address - Fax:212-769-1916
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008921-1103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist